Is Spine Surgery Safe ?

Many of us are suffering from spine diseases. In fact all over the world back ache is the second commonest reason to see a doctor. Most of the spine problems can be treated with life style modification, exercises and medications. But there are few spine problems like spinal tumors, slipping of vertebrae, Disc prolapse, Spinal instability, Spine fractures etc which may require surgery. But since many of us are scared of spine surgery we are forced to bear the pain or live with the disabilities rest of our life rather than undergoing surgery. This reluctance to surgery is not totally irrational as we keep seeing the complications associated with spine surgery like intolerable pain, prolonged bed rest, disabling paralysis, bowel and bladder problems, bedsores etc associated with spine surgery . Recent developments in the field of spine surgery have radically changed this scenario. Now spine surgery is as safe as any other surgery. Let us look in to the various factors that contributed to this.

The first and foremost factor that made spine surgery safe is the widespread use of MRI and CT scans in the diagnosis of spine disorders. Earlier it was done entirely based on the clinical experience of a doctor. Now it can be corroborated with the scans .The scans help not only in identifying the nature of the disease more accurately but also in locating the site of disease more precisely. So the chance of operating a wrong place for a wrong reason becomes negligible now.

Next major advancement in the field of spine surgery is the availability surgical equipments like operating microscopes , endoscopes ,C-arm, O– arm, implants, newer instruments etc . The microscope and endoscope can enlarge the surgical field many times with out losing the clarity. So during the operation small nerves and other structures can be seen clearly and can be preserved . These instruments have cool bright light which can be directed to the nooks and corners of operating field and surgeon can visualize the entire field with out hindrance. Now advanced bio compatible implants ranging from small titanium screws to artificial discs are available in the market. These implants are developed after extensive studies on the biomechanics of the spine, strength and durability of implants. There are also specialized instruments available to place these implants accurately. With the availability of new implants the philosophy of surgery also changed from fusing the neighboring blocks of vertebrae for strength to bring back the natural mobility of spine along with the stability . The precise area to be operated and accurate placement of implants are now determined using instruments called C- arm and O -arm. This is done by comparing the MRI and CT scan pictures placed in the lobby or computer screen with the real time C– arm or O-arm pictures in the screen taken during surgery. Complicated Spine surgery like scoliosis correction where the spine is twisted in many directions , can be done now easily with the help of Spine Navigation System.

When better instruments are made available better approaches and techniques to tackle the spine diseases are also developed. Traditionally during surgery the spine was approached from behind as the front of spine is studded with important structures of chest and stomach. The spinal cord and nerves are placed approximately in the middle of vertebra and when the part affected is front of spinal cord it is very difficult to approach from behind. Now the spine is approached from all around through laparoscopy, thoracoscopy etc. Similar to other surgical specialties the latest trend in the Spine surgery is the Key Hole approach . This was again made possible by the invention of a specialized instrument called X tube. Earlier during surgeries the spine is approached by making a big skin opening and then the muscles are pulled to the sides using retractors. As we go towards inside the opening becomes small and small similar to a cone with the bigger circle outside and smaller circle inside. In X tube this is reversed where after making a is small opening in the skin the instrument is introduced inside the body and then the inner part is expanded. This concept has revolutionized the Spine surgery and now various modifications of this system are available not only for removing the Prolapsed disc by Micro Lumbar Discectomy but also for stabilizing the near by Vertebrae using transpedicular screw and rod fixation in Slipping of vertebrae. This fixation can also be done with another Key hole method called Percutaneuos transpedicular screw and rod fixation . Compression Fractures mainly due to osteoporosis of the spine can be now easily operated using Vertebroplasty which is a day care surgery. Cervical Spondylosis with Disc prolapse affecting the nerve going to the hands does not require a big surgery of putting the plate ,screws and graft now . This can be done using a 2 cm opening from behind called Laminoforaminotomy and patient can go home next day.

So key hole surgeries of the spine along with special instruments, microscopes and endoscopes made the spine surgery pain free. Hospital stay is reduced to one or two days and patient is mobilized early. This helped in the early initiation of Physiotherapy and exercises which leads to earlier and better recovery. Finally the spine surgery has become Safe Surgery Now