Aplication Fields

Spine Surgery

Objective

Correct structural abnormalities of the spine.

Rationale Fundament

Correction of structural abnormality that causes back pain, when that is the cause. For example, when a herniated disc compressing a nerve root, and all non-surgical treatments have failed, remove the herniated disc material eliminates compression.

Scientific evidence of its effectiveness

Some evaluation methods, scientifically optimal, may not apply to the case of surgery for their own characteristics. For example, it is not acceptable to stop operating a group of patients in whom surgery is necessary, according to currently accepted criteria to demonstrate that they operate are not paralyzed.

? There is a compression of the nerve roots or spinal, important enough to sequelae if not resolved quickly (this is the case of the intervention "syndrome cauda equina due to disc herniation"

? There is a compression of the nerve roots, although not necessarily going to leave sequelae, symptoms and causes lasts more than 6 weeks without improvement despite nonsurgical treatments, and

? The characteristics of the clinical manifestations and the results of the physical examination should demonstrate chelates compression is undoubtedly a structural abnormality detected.

Risk and contraindications

Some of the recommendations based on scientific evidence establish that the risk of infection or bleeding during first intervertebral disc surgery is less than 1%, although this risk increases greatly with older patients or when it is not the first disc operation.

The real risk is that the operation does not have satisfactory results. Some of the recommendations based on scientific evidence establish that, among patients with disc herniation without obvious signs of nerve compression by physical examination oelectromiograma, less than 40% of those who obtain satisfactory results. Scientific studies show that the main cause of surgical failure is operating on patients who should not be and the more strict is the selection of patients referred for surgery, the better the results thereof.

Another risk of surgery is the post-surgical fibrosis. It is accepted that the less aggressive surgery and minor bleeding during the operation, the less likely it appears.

Moreover, the surgery requires a minimum overall health. Some general diseases, such as heart, lung or metabolic, may prevent it.

Major surgical techniques

Laminotomy: It is a technique for operating herniated discs. It consists in reaching the nerve root and herniated disc opening the space between the sheets of two juxtaposed vertebrae. By expanding the foramen, the nerve root is decompressed.

1. Nerve Root 2. Spinous process 3. Hole conjunction 4. Facet Joint 5. Transverse process 6. Bone

Discectomy: A technique to operate herniated discs. Only involves removing the herniated disc material, without breaking or removing the vertebral bone.

Microdiskectomy is a discectomy that is performed using a microscope with a very small incision and surgical manipulation and, therefore, within a very short recovery. Where it really should be operated, and it is technically possible to use this technique, microdiscectomy is the procedure of choice, because you get results similar to those of discectomy results shortening recovery time and reducing costs.

Laminectomy: Is to remove the entire sheet of a vertebra, which also decompresses the nerve root. It is also used in cases of spinal stenosis, to decompress the médula.Los studies show that scores lower than discectomy, microdiscectomy and laminotomy for the treatment of disc herniation.

Interspinous devices

It is a surgical technique used specifically in certain cases of symptomatic spinal stenosis. Involves placing a small implant between the spinous processes of the vertebrae through a small incision in the patient's back. The implementation does not require general anesthesia and can be performed under local anesthesia. Its aim is to keep separate the posterior portion of the vertebrae and open the spinal canal.

The placement of an interspinous device is less invasive than traditional surgery, has fewer surgical complications, leads to less blood loss and duration of operation, and shortens hospital stay. In return, the probability that the patient needs to be re-operated over the next two years is greater if an interspinous device is placed if a laminectomy is performed (with or without fusion), and even more if placed in two vertebral levels.

Arthrodesis: Set consists of two vertebrae. It can be done by placing a bone graft between two vertebrae ("non-instrumented fusion") or also using metal plates to fix both ("instrumented fusion") vertebral bodies. It is used in cases of scoliosis or spondylolisthesis to be operated. Sometimes, even after doing a laminectomy, to avoid instability of the vertebra which sheet is removed.

Chemonucleolysis: It is a technique for the surgical treatment of herniated discs. It involves injecting a "chymopapain" -called substance - inside the disk. This substance destroys the nucleus pulposus. This reduces disc pressure and compression on the nerve root and also destroys the substances contained in the nucleus pulposus and trigger neurogenic inflammation.

Percutaneous Nucleotomy: Involves removing the nucleus pulposus of the intervertebral disc through a small incision in the skin. Scientific studies have shown to be ineffective, and it no longer applies.

Nucleoplasty: Involves removing the nucleus pulposus and put in place a prosthesis. It was initially developed for the treatment of disc cracks, although there is considerable commercial pressure to promote its use in cases of "disc degeneration". Scientific studies are of poor methodological quality and do not support that is effective to treat any such conditions.

Ozone Therapy: Initially developed for the treatment of disc herniation and involves injecting a gas (ozone) inside the disk. There is considerable commercial pressure to apply this technique, which led to the injection of ozone (on disk or elsewhere-in the facet joint or musculoskeletal) were applied in other cases. However, no studies suggest that this technique is effective.

IDET -electrotermocoagulación intradiscal-

These two techniques developed for the treatment of pain originating in the intervertebral disc. Involves placing electrodes in the intervertebral disc and heat in order to burn the nerves responsible for transmitting pain originating therein and eventually join the fibers of the fibrous the disk (in the case of disc cracking).