Spine
Anterior Cervical Corpectomy and discectomy/fusion
What is Anterior Cervical Corpectomy Fusion?
During an anterior cervical corpectomy fusion treatment, the neck’s bones are fused to make them stable and non-mobile. To remove all or some of the vertebrae, place a cage or graft into the disc area, and then secure a titanium plate across the space to hold everything in place, the surgeon makes an incision in the front of your neck. Any discs or bone material that may be pressing on the spinal cord or nerves are removed before the neck is fused together to lessen the strain on them. Most patients stay in the hospital for 2-3 days. Before you can go home, you need to be able to
- Control your pain by taking oral pain medications.
- Get up and walk around on your own
- Empty your bladder
If you are unable to do these activities or if you have any problems from your surgery, you may need to stay in the hospital longer.
Other Orthopedics Treatments
A surgical technique called anterior cervical discectomy and fusion (ACDF) decompresses the cervical spine’s spinal cord and nerve roots in order to stabilize the affected vertebrae and treat nerve root or spinal cord compression. When other non-surgical treatments have not worked, this technique is used.
The hemiated disc’s nucleus pulposus, the center of the disc that resembles jelly, protrudes through the annulus, the surrounding wall, and pushes against the nerve root next to it. Inflammation of this nerve root results in excruciating agony. Degenerative disc degeneration may also be the issue. (spondylosis). About 80% of the disc is made of water. As one ages, the disc begins to dry out and diminish, resulting in minor annulus tears and inflammation of the nerve root.
Through a tiny incision in the front and on the right or left side of the neck, the neurosurgeon or orthopedic surgeon accesses the region between two discs. Arthritic bone spurs are also entirely removed along with the disc. After that, the disc debris that was impinging on the spinal nerve or spinal cord is entirely removed. The spinal nerve is then given more space to leave the spinal canal by having the intervertebral foramen, the bone channel through which it travels, enlarged with a drill.
The open area is frequently filled with bone graft to increase stability and avoid the vertebrae from collapsing. “Fusion” refers to the gradual process of the bone transplant fusing the vertebrae together. When more than one disc is involved, it is sometimes necessary to screw a titanium plate onto the vertebrae or insert screws between the vertebrae to improve stability during fusion.
The procedure necessitates a brief hospital stay of 1 to 3 days and a gradual recovery period of 1 to 2 weeks. For up to 8 weeks, the patient may be instructed to wear a neck collar or brace to maintain correct spinal alignment. The brace helps to avoid motions (such as sudden and/or excessive neck bending or twisting) that could exacerbate or delay the healing process by increasing one’s awareness of posture and positioning. Wearing a protective neck brace is particularly advised when moving around (such as in a vehicle), sleeping, taking a shower, or doing any other activity where the patient might not be able to ensure proper spinal alignment. In addition, physical therapy and related healing modalities (eg, massage, acupuncture) may be recommended in order to promote proper healing, as well as to strengthen the surrounding muscles that can take over the neck brace’s ‘job of ensuring proper spinal alignment when the patient starts (around 4 to 6 weeks after surgery) to wean off the neck brace.
Cervical Disc Replacement Surgeries
The seven bones in your neck region that are collectively referred to as cervical vertebrae make up your cervical spine. Your neck can move easily because of the cervical discs, which serve as shock absorbers and cushions between the cervical vertebrae.
Additionally, the upper portion of your spinal cord can travel through a tunnel formed by your cervical spine that is protective. Spinal nerves are sent out as your spinal cord travels through this tunnel and travel through the spaces between your cervical bones. These spinal nerves transmit feeling and movement to your upper torso.
An unhealthy cervical disk is removed during cervical disk replacement operation, and a synthetic disk is put in its place. It is done when the part of your vertebrae or your cervical disk is pressing on your spinal cord or spinal nerves, causing you discomfort, numbness, or weakness. Disk repair may be advised if these symptoms do not improve with nonsurgical treatments.
Using an artificial cervical disk in place of your natural one is an unfamiliar treatment that was just authorized by the FDA. Traditional cervical disk surgery involves removing the damaged disk and possibly fusing the cervical bones above and below it. It’s a good idea to have a backup plan in place, especially if you have a lot of valuable data that you need to access.
Reasons For The Procedure
Wear and tear, or cervical disk degeneration, is frequent: With time, the cervical disks start to bulge and collapse; most individuals experience this by the age of 60. Doctors are unsure of why some patients experience more signs of cervical disk degeneration than others, though.
Your Symptoms May Include
- Neck pain
- Neck stiffness
- Pain that travels down into your shoulders or into your arms
- Weakness of your shoulders, arms, hands, or legs
- "Pins and needles" or numbness in your arms
MicroDiscectomies
Discectomy
A discectomy (also termed open discectomy) is the surgical removal of herniated disc material that rests on a nerve root or the spinal cord. The nucleus pulposus, the portion of an intervertebral disc that presses on the spinal cord or radiating nerves and produces pain, is removed during the procedure. Ross and Love released Love's technique, also known as the conventional open discectomy, in 1971. Effective alternatives to conventional discectomy treatments have been created thanks to options advancements. (ie Microdiscectomy, Endoscopic Discectomy, and Laser Discectomy). A laminotomy is frequently performed in addition to the standard discectomy to allow entry to the intervertebral disc. A small piece of bone (the lamina) from the affected vertebra is removed during this operation to give the surgeon greater visibility and access to the disc herniation.
Microdiscectomy
A piece of a herniated nucleus pulpolsus is removed during a minimally invasive surgical technique called a microdiscectomy using a surgical instrument, a laser, and a loupe or operating microscope for magnification.
Anterior lumbar interbody fusions surgeries
Overview and Indications
A form of spinal fusion called anterior lumbar interbody fusion (ALIF) uses an anterior (front-through-the-abdomen) approach to fuse (mend) the lumbar spine bones together. Interbody fusion, in this instance performed via an anterior method, entails the removal of the intervertebral disc and its replacement with a bone (or metal) spacer.
When multiple spinal levels need to be fused and multiple discs need to be removed, the anterior method is frequently preferred. ALIF can be carried out with or without instrumentation—the insertion of metal screws or rods—as well as a posterior resection (laminectomy).
When only one spinal level is fused and a posterior decompression and/or instrumentation are not necessary, the anterior ALIF approach is also optimal. The aorta, vena cava, and the intestines must be temporarily moved out of the way during the anterior lumbar ALIF approach, but the spinal nerves and other neurologic structures are not retracted, allowing for a broad exposure of the intervertebral disc. (and therefore, a decreased risk of neurologic injury).
Surgical Technique
The procedure is carried out under general anesthetic. During operation, an endotracheal tube is inserted, and the patient uses a ventilator to help them breathe. Antibiotics are injected intravenously prior to surgery. In general, a special, radiolucent operating tab is used to place patients in the supine position (lying on their backs). A unique cleaning solution is used to sanitize the surgical area (the abdominal area). To keep the area free of germs, sterile drapes are used, and the surgery team dons sterile surgical gear like gowns and gloves.
After that, a specialized biting and grasping instrument is used to extract the intervertebral disc. (such as a pituitary rongeur, kerrison rongeur, and curettes). Restoration of the disc’s normal height and selection of the proper size spacer are done using specialized tools. The disc space is then meticulously filled with a bone spacer (metal or plastic spacers can both be used). In order to ensure that the spacer is positioned correctly, fluoroscopic x-rays are obtained.
The region around the wound is typically cleaned with sterile water that contains antibiotics. With a few powerful sutures, the de fascial layer and subcutaneous layers are closed. Most of the time, the epidermis can be closed with the help of surgical glue, leaving only a small scar and necessitating bandaging. Depending on how many spir levels are involved, the overall surgery time ranges from 2 to 3 hours.
Posterior Lumbar Interbody Fusion Surgeries
The surgical procedure known as spinal fusion, which is used to repair problems with the vertebrae, is basically a welding procedure. The fundamental concept is to heat the painful vertebrae into a single, solid bone by joining them together.
A posterior lumbar interbody fusion (PLI), like all spinal fusion surgeries, involves inserting bone graft into the spine to trigger a biological reaction that causes bone to grow between the two vertebral elements, stopping motion at that segment.
The PLIF accomplishes spinal fusion in the low back instead of the posterolateral gutter fusion by inserting a cage made of allograft bone or synthetic material (PEEK or titanium) right into the disc space. A posterior lumbar interbody fusion (PLIF) is the name of the process when the surgical approach for this kind of procedure is from the back.
In addition to PLIF fusion, simultaneous posterolateral spinal fusion surgery is frequently performed.
Description
First, a three to six inch long cut is made in the midline of the back to access the spine. The left and right lower back muscles (erector spinae) are then separated from the lamina on both sides and at various levels.
After approaching the spine, a laminectomy is performed to expose the nerve origins by removing the lamina. The nerve roots may then be given more room by trimming the facet joints that are immediately over them.
The disc space is then cleared of disc debris after the nerve roots have been pulled back to one side. The disc cavity is then filled with an allograft bone cage or posterior lumbar interbody cages with bone graft, and the bone grows from vertebral body to vertebral body.
PLIF Potential Advantages and Disadvantages
The benefit of performing a pure PLIF surgery is that it can fuse the disc space anteriorly without requiring a second incision, which is required for an anterior/posterior spinal fusion surgery. But there are some drawbacks. With a posterior technique, less disc space can be removed. (bom the back).
A much more thorough evacuation of the disc region is made possible by an anterior approach (an ALIF from the front), which increases the amount of surface area that can be fused. An anterior approach allows for the insertion of bigger spinal implants and offers better stabilization.
A posterior approach alone & more challenging to reduce the deformity in instances of spinal deformity (e.g., isthmic spondylolisthesis). The chance of a cage retro pulsing back into the canal and causing neural compression is tiny but real when it is inserted posteriorly.
The bone is inserted into the anterior section (front) of the spine during PLIF surgery, which increases the likelihood of a solid fusion compared to posterolateral fusion. Since there is more surface area here than in the posterolateral gutter, and because the bone is compressed, the anterior part of the bone fuses better. Wolff’s law states that bone reacts to stress, but bone under tension does not experience as much stress, which is why bone in compression heals more effectively.
Transforaminal Lumbar Interbody Fusions With Instrumentation
The surgical procedure of spine fusion (such as a TLIF) stabilizes the spinal vertebra and the disc or shock absorber between the vertebrae. The goal of lumbar fusion operation is to stop any movement between the adjacent vertebrae by building solid bone between them. The surgery’s objective is to lessen discomfort and nerve irritation.
Reasons For TLIF Surgery
- Spondylolisthesis
- Degen Disc Disease
- Herniated Disc
Spinal fusion may be recommended for conditions such as spondylolisthesis, degenerative disc disease or recurrent disc hemlations. Surgeons perform lumbar fusion using several techniques.
Benefits of TLIF Back Surgery Technique
- The TLIF procedure has a number of potential benefits over some other lumbar fusion techniques.
- Because bone graft is positioned in the disc region as well as along the posterior gutters of the spine, bone fusion is improved.
- In order to relieve pressure on the nerve roots and reestablish normal height, a spacer is inserted into the disc space. It also helps to open up nerve foramina.
- A TLF procedure enables the surgeon to insert bone graft and spacer into the disc space from a unilateral approach laterally without having to forcibly retract the nerve roots as much, which may reduce injury and scarring around the nerve roots when compared to a PLIF procedure.
Before TLIF surgery, as with all lumbar spine fusion procedures, a medical clearance is sought.Smoking should be stopped. Patients may require pre- donation of blood to be used at the time of surgery.
