Spinal surgery ; Techniques and Advances

Spine surgery aims to cure conditions such as herniated discs, spondylolisthesis, scoliosis and stenosis, now also thanks to minimally invasive and robotic techniques.

When we speak of spine surgery, we are referring to a range of surgical interventions to treat various pathologies and conditions affecting the spine.

Technological and scientific advances have led to major innovations in the field of spine surgery, so much so that many operations are now performed minimally invasively, even with the aid of spine robots.

The aim of these methodologies is precisely to reduce the impact of surgical and post-operative actions, taking into account the fragility of the intervention zone.

 The pathologies on which the spine surgeon mainly intervenes are :

• scoliosis
• herniated disc
• kyphosis;
• fractured vertebrae;
• stenosis;
• cervical myelopathy;
• spondylolisthesis;
• vertebral osteoporosis;
• vertebral metastasis.

As a spine surgeon, in charge of the Humanitas group of the Orthopedic and Spine Surgery Unit 1 at the best hospitals and clinics in Turkey, he is responsible for the entire spine surgery process.

This article focuses on minimally invasive and robotic spine surgery, a revolution in the orthopaedic field.

This is a set of high-precision procedures for the treatment of various spinal pathologies, with the aim of reducing the impact of surgical and post-operative actions.

We will first discuss the pathologies for which surgical treatment is envisaged, then analyze the surgical procedures.

Spinal surgery

Spinal surgery in Turkey  is the decisive treatment in case of failure of conservative therapies: it is important to emphasize this aspect, as in most cases, pharmacological treatment combined with an appropriate physiotherapy course can lead to excellent results, without having to resort to surgery.

Therefore, depending on the pathology, the most suitable treatment is identified: in most cases they can be performed with minimally invasive technique.

These include:

• the decompressive laminectomy;
• spinal fusion;
• lumbar microdiscectomy;
• anterior cervical discectomy;
• vertebroplasty and percutaneous kyphoplasty.

The real revolution in the field of spinal surgery is occurring, as mentioned earlier, with Minimally Invasive Surgery, which allows all the procedures listed above to be performed minimally invasively and with very little impact on the patient’s body.

This allows for much smaller skin incisions, with total sparing of muscles and minimal involvement of adjacent structures, with:

• less bleeding;
• shorter postoperative recovery;
• reduced surgical time;
• increased mobility;
• accelerated functional recovery.

Finally, more and more studies are focusing on robotic spine surgery, particularly in the treatment of complex deformities such as scoliosis, kyphosis, and spondylolisthesis.

Let us now look at the techniques.

Decompressive laminectomy

Decompressive laminectomy is the treatment of first choice in cases of spinal canal stenosis.

The procedure involves removal of the vertebral laminae causing compression of the spinal roots: it can be performed with minimally invasive technique, preserving the paraspinal structures and improving postoperative recovery.

It can also be considered in cases of:

• severe disc herniation;
• unstable spondylolisthesis;
• osteophytosis of the spine.

Removal, in the latter case, is considered only in extremely severe cases unresponsive to other treatments.

Spinal fusion

Spinal fusion is the surgery of choice for the treatment of severe scoliosis (over 40° Cobb), as well as:

• severe hyperkyphosis (over 70° Cobb degrees);
• severe disc herniation with spinal instability;
• symptomatic spondylolisthesis;
• spinal stenosis with spinal instability.

The procedure in question involves the application of rods and screws (modernly also percutaneously) by the spine surgeon following manual repositioning of the spine (within the limits allowed by its flexibility).

Next, bone fragments are placed that initiate the fusion process, making the affected vertebrae stable and immobile.

An operation intended for rare cases, spinal fusion makes the spine stiffer but less curved and more stable, preventing the progression of both curvature (in the case of scoliosis) and associated symptomatology.

Increasingly in vogue back in our day is the formerly well-known dynamic stabilization (without arthrodesis).

Widely used in the early 2000s, it responds effectively to the increasing demands of people to maintain “freedom of movement” while effectively stabilizing their spine.

We will soon return to this very important concept and the possible applications of dynamic spinal stabilization.

Lumbar microdiscectomy

Performed under general anesthesia, microdiscectomy is done with the aid of an operating microscope, inserted through an access of less than 3 cm at the height of the affected vertebra.

This treatment is intended for severe hernias of the lumbar spine, releasing nerve compression and limiting the amount of bone to be removed.

With microdiscectomy, damage to paraspinal tissues is limited significantly, making it a less invasive technique than “open” discectomy.