The image of spine surgery among the lay
population (and even among doctors) has been a negative one. Factors contributing to this included poor outcomes caused by damage to the stability of the spine, damage to neurologic structures as well as prolonged disability or rest following spinal operations.
The last decade has been the emergence of spine surgery as an established speciality, and has seen dedicated spine surgery practices. This was a result of a natural course of specialization due to a better understanding of spinal pathologies, advanced imaging modalities as well as revolutionary refinements in surgical techniques.
Advances in imaging improved the understanding of spinal disorders. Just as plain X-rays revolutionized orthopaedics, and CT scans neurosurgery, the coming of the MRI scan provided a completely new and much refined insight into the structure of the spine and its anomalies. Newer generation MRI’s provide even cleared delineation of pathology, and dynamic MRI’s would further add to the useful information obtained. Only when the anatomic basis of a disorder is known can the management be rational, and thus spine surgery benefited the most from this advance.
Surgical techniques have also seen a major change for the better. New techniques adapted to spine surgery has made it safer and more effective in improving results.
- Micro-surgery : Use of an operating microscope improves the visualization of delicate structures such as the nerve roots and the spinal cord. It also helps to decrease the size of the incision.
- Minimally invasive surgery : Specialized instruments and techniques help to decrease the invasiveness of modern spine surgery. Lumbar canal stenosis is decompressed without performing a laminectomy. Disc excision performed by a micro-discectomy is the least invasive, and such patients can be mobilized within a few ours of surgery.
- Percutaneous procedures : Vertebroplasty consists of injection of bone cement into osteoporotic fractures. In addition biopsies and therapeutic injections are performed percutaneously using image intensification.
- Spinal fixation devices : Modern spinal implants made of titanium are available for stabilization of the spine. These are used to reconstruct structurally damaged spine because of trauma, tuberculosis, tumours or degenerative disease and to correct spinal deformity effectively.
- Prosthesis : Vertebral or disc resections are reconstructed using cages made of titanium or plastic. Mobile disc replacements are also on the anvil.
- Anterior spinal surgery : Anterior approaches to all regions of the spine lead to more effective tackling of the various pathologies.
This renewed interest has been the evolution of spine surgery as a distinct speciality, with surgeons trained in basic orthopaedics or neuro-surgery adopting spine surgery as an exclusive field of interest. High quality training programmes and fellowships are available both internationally and locally, and a new breed of highly trained and competent Spine Surgeons is emerging.
The incidence of spinal disorders is on the rise. Contributory factors include high velocity travel, the re-emergence of infective disorders such as tuberculosis, and a higher incidence of survivors of malignant disease leading to more patients with metastatic disease. But the most important factor is the improvement in life-expectancy as well as quality of life expectations of the elderly population. Degenerative disorders form the largest group of patients requiring surgical care for the Spine, and thus the patient population is expanding rapidly.
The future too holds some exciting possibilities. The development of recombinant DNA techniques, stem-cell technology and gene therapy would change the face of therapeutics for spinal pathologies. Improvement in surgical techniques would include the use of better optics as in endoscopy as well as computer guided navigation surgery. More importantly, improvement in neuromuscular rehabilitation would improve quality of life for the patients.
Thus the speciality of Spine Surgery is set for enormous growth in the years to come, and one hopes, that the person to benefit the most from this is the patient.
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