What is Spine Surgery?

The spine is a bridge made up of bones, joints, and discs that extend between the head and the coccyx, carrying a large portion of the body’s mass.

 

The spine is a bridge made up of bones, joints, and discs that extend between the head and the coccyx, carrying a large portion of the body’s mass. Many conditions, such as aging, postural problems, trauma, and structural abnormalities, can damage the spine. In spine-related issues, which typically first manifest as pain, the primary goal is to alleviate symptoms through non-surgical treatments and conservative (protective) approaches. In some more serious cases, spine surgery may be necessary to perform delicate surgical operations.

The spine, which houses one of the most critical parts of the central nervous system—the spinal cord—consists of 33 vertebrae, 23 of which have the ability to move. A healthy spine appears as a straight column when viewed from the back and has a curved structure when viewed from the side. Various conditions, such as aging, postural problems, trauma, and structural abnormalities, can damage the spine, leading to different disorders. In general, the initial manifestation of spine problems is pain. The first line of treatment aims to address symptoms and preserve spine health through non-surgical and conservative approaches. However, in more severe cases, spine surgery becomes necessary to carry out precise surgical procedures. These procedures are performed by doctors specializing in spine surgery in hospitals.

What is Spine Surgery?

Spine surgery is a surgical specialty that deals with the surgical treatment of diseases related to the spine. Functional, structural, or mechanical problems in the spine can manifest as pain, limited mobility, and loss of strength and sensation. Disc problems, osteoarthritis in spinal joints, spinal curvatures, hernias, certain congenital diseases, tumors, and infections can all contribute to these issues. Surgeons involved in the treatment of these problems are specialists in Neurosurgery or Orthopedics and Traumatology, having received special training in spine surgery. In spine surgery clinics, which work in coordination with medical units such as neurology, physical therapy, and rehabilitation, many diseases like scoliosis, herniated discs, spinal trauma, degenerative diseases, and spinal tumors and infections are diagnosed, treated, and monitored from a multidisciplinary perspective. Surgical treatments for these conditions are highly delicate operations, and their main goal is first to halt the progression of the disease and then to achieve significant clinical improvement.

Types of Spine Surgery

The spine is a complex structure, and the surgical treatment techniques for each part and each problem located within these regions can vary significantly. The most valuable factors in solving such complex problems are "Experienced Doctors" and the "Technological Infrastructure" that can elevate this experience to higher levels. Although modern surgical techniques cover a wide range, we can categorize some of them under the following headings:

Discectomy and Microdiscectomy
When the cartilage cushions between the vertebrae are damaged and press on the spinal cord and/or the nerve roots emerging from it, this is referred to as "Disc Herniation / Lumbar-Cervical Disc Herniation," and the surgical removal of this herniated disc is called "Discectomy." Discectomy performed with minimal invasive techniques is referred to as "Microdiscectomy." Microdiscectomy remains the gold standard surgery worldwide.

Disc Prosthesis Placement
This procedure involves removing a damaged spinal disc and replacing it with an artificial disc (Disc Prosthesis) designed for this purpose. This method is mainly used in cervical (neck) surgeries but can also be applied in selected patients in the lumbar (lower back) region. The secondary goal of this surgery is to maintain the spinal mobility of the operated area.

Laminectomy
In patients with spinal stenosis (narrowing of the spinal canal), laminectomy involves removing part or all of the lamina, which is the thin bony part at the back of the spine, to increase the diameter of the canal. This relieves pressure on the spinal cord and nerve roots. This operation is the most commonly performed procedure for lumbar spinal stenosis. However, in some cases, where laminectomy alone is not sufficient, it can be combined with spinal fusion surgery.

Spinal Fusion/ Stabilization
The spine is a structure formed by 33 vertebrae that have complex functional and mechanical connections. Certain diseases can disrupt both the mechanical and functional integrity of two or more vertebrae, resulting in conditions such as vertebral slippage (spondylolisthesis), kyphosis (humpback), and scoliosis (lateral curvature). To correct these abnormalities, the process of permanently connecting two or more vertebrae is called spinal fusion/stabilization. This method is preferred in the treatment of spinal fractures, trauma, disc degeneration, and damage. The surgery can be performed with or without instrumentation, depending on whether screws and rods are used, or with the use of bone tissue taken from another part of the body.

Corpectomy
Corpectomy involves the complete or partial removal of one or more vertebrae. These surgeries are typically performed in cases where the spinal integrity is completely lost due to diseases affecting the vertebral body, and other treatments cannot restore the damaged vertebra. This condition generally arises from trauma, tumors, or infections. In cases where the entire vertebra is removed, a device known as a "cage" is placed in place of the removed vertebra to restore spinal integrity, usually combined with stabilization and fusion procedures.

Vertebroplasty
Vertebroplasty is a procedure in which bone cement (acrylic-based) is injected into the vertebra in cases of spinal fractures or metastases of cancer to the vertebrae. The process involves advancing a needle, about 2 mm in diameter, into the center of the vertebra under fluoroscopy or O-arm CT guidance, and injecting bone cement through this needle. The material, when injected in a paste-like consistency, hardens within 5-15 minutes, increasing spinal strength, easing pain, and contributing to the partial destruction of tumor cells in that area.

Risks of Spine Surgery

The majority of spine surgeries involve irreversible procedures. Therefore, before making the decision to proceed with surgery, the patient should be thoroughly evaluated by a team of experts, and a multidisciplinary review of the necessity of surgery should be conducted. Patients who are determined to need surgery are usually those in whom all other medical treatment options have been ineffective, the disease has progressed significantly, has severely impacted quality of life, or where sudden neurological damage has occurred. In such cases, the only treatment method is spine surgery, which will be performed using the appropriate technique.

As with all types of surgery, spine surgery carries some low-probability risks. Some of these risks include:

• Adverse reactions to anesthesia or medications
• Infection
• Bleeding
• Nerve damage
• Degeneration such as fractures in implanted devices

Although these risks are unlikely, they may occur in spine surgery operations, and the doctor will provide necessary information regarding these risks. In surgeries performed by experienced and specialized surgeons, these risks are minimized. It is crucial that the patient is well-informed about the potential gains from surgery and any possible unexpected situations that may arise post-operatively, in order to prevent any adverse outcomes after the operation.

Advantages of Spine Surgery

Spine surgery provides a treatment method for severe issues such as significant muscle strength loss, intense neck, back, and leg pain, noticeable sensory loss, numbness around the hips, urinary problems, and loss of sexual function. In cases where non-surgical methods cannot treat these problems, spine surgery is necessary. Spine surgery largely eliminates these severe complications that can greatly affect the quality of life. For patients with appropriate profiles, minimal invasive techniques can be used in spine surgery, offering advantages such as lower complication risks and faster recovery times. Therefore, healthcare institutions that are competent in performing operations with minimal invasive surgical techniques are beneficial for treating spine diseases.

Disadvantages of Spine Surgery

In cases of chronic back pain associated with non-specific and degenerative disorders, the most common surgical procedure performed is spinal fusion. This operation, which involves joining vertebrae, limits the ability of the nerves to stretch and reduces the mobility of the spine. While this limitation can be considered a disadvantage, it does not create a significant restriction on daily activities. Therefore, considering the risk-benefit relationship, this limitation can be accepted, especially when there are severe symptoms. Another risk of spinal fusion is the possibility that the bones may not fuse completely. This rare issue may require a second surgery. However, smoking, which hinders bone fusion, significantly increases the risk of this complication. Therefore, patients who smoke after spine surgery should quit this habit.

If you are experiencing symptoms like pain, limited movement, or sensory loss, which may indicate spine-related issues, you can visit a healthcare facility to undergo examination and diagnostic tests. If a spine disease is detected, you can receive treatment according to the recommendations provided by your doctor regarding spine surgery and other treatment options, leading to a better quality of life.