Surgery on Spine

What are the common disorders that may require surgery on spine?

Some of them are:

• Disc Problems due to severe pain and nerve compression or muscle weakness
• Spinal Stenosis or narrowing of nerve causing compression
• Spine Instability causing pain due to imbalance on one bone on top of another
• Spine Infections like TB or other bacterial infections
• Cancer of Spine: usually from other sources like breast, intestine, prostate, lung etc.
• Scoliosis and other Spinal deformities

What is the position I will be operated in and what anesthesia is given ?

Usually patients are operated on a table designed for spine with bolsters / special frame on top. This will ensure that the abdomen and chest hangs free ensuring free breathing and less bleeding. The patients are given General Anaesthesia which involves putting the patient to sleep and introducing a breathing tube down the air passage. Patient is monitored by the Anaesthesia team and all vital signs are checked and optimized throughout the procedure. The anaesthetist may also introduce several cannulas into the veins to inject medicines and fluids into the body during the procedure.

In long spine surgeries it is also usual to introduce a urine tube for draining the urine collected. This provides an outlet for the urine collected and is useful for monitoring the hydration and blood loss of the patient.

What are the risks and complications of Spine Surgery?

Surgery on spine is a major undertaking. It is done after careful planning and consideration of patient symptoms. As with most surgical procedures it has its share of complications, some of them specific for spine.

Immediate:

• Anaesthesia Related complications: This is general and is similar to many other surgical procedures. There is some additional risk due to the fact that the patientis anaesthetized in face down position, and that in some deformities the lung ventilation is abnormal.
• Positioning related issues: Spine surgery is done with patient lying on his stomach. Even though the anaesthetist will take all precautions, this sometime can cause un- intended pressure on the eyes, face, chest or genitalia.
• Excessive Blood Loss: This is due to the tissue cutting involved in exposing the spine and also from the bone itself. There are several measures in anaesthesia, medications and tissue dissection techniques which help to reduce it. However, most major spine surgeries require transfusion of blood from blood bank.
• Infections: This is a general risk with all open surgeries, especially if it involves metal implants. This is more if the patient's immunity is weak as in diabetes / other disorders.
• Nerve / Spinal cord injury: This can happen because of microscopic / gross inury while opening the spinal canal to relieve the compression on the nerve and mobilising the nerve. Usually it is caused by adhesions of the nerve to underlying ligaments and bone. If there has been a previous surgery done then the scarring is expected to be very high resulting in poor differentiation of tissues. The incidence in medical literature is said to be around 1 -2 % but it varies greatly with the nature of procedure attempted and the severity of compression. In long standing compressions / very bad spinal deformities, the nerve injury rate is expected to be high.
• Failed back surgery syndrome: This happens when surgery is done for back pain but pain is not relieved after surgery

Late:

• Screw / Implant breakage: This is a common occurrence in many spine surgeries especially ones that involve extensive surgery. The idea of surgery is to join one bone to another so that the nerves are not compressed and they done move with respect to one another. The role of metal implants is to mainly hold the bone till the bone joins another bone. The time duration this happens is on an average about 4 - 6 months. This depends on the extent of surgery and the technique. If the implant breaks, it may necessitate removal / reinsertion of new ones.
• Non- fusion of vertebra: The idea of spine fusion is to stop relative motion between the vertebra causing the compression. In some cases the vertebra do not fuse to one another despite best attempts. This will necessitate additional procedures like bone grafting as the implants can break if the fusion is delayed.

Will I be able to get back to my original functional level after surgery ?

The answer depends on the amount of compression on the nerve and the preexisting wear and tear that is present. Most patients with minor wear and tear or adolescent scoliosis do get back to most activities that they used to do. In patients with extreme wear and tear or osteoporosis it is prudent to restrict activities a little bit to prevent complications. Nevertheless, all spine care advice and exercises have to be followed meticulously for life to decrease the chances of problems.