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New advances in spine surgery

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New advances in spine surgery

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New advances in spine surgery

  1. 1. New advances in spine surgery Dr Attila Szabo Orthopaedic Surgeon Special Interest in Spinal Disorders MEDICLINIC CAPE TOWN http://www.spinesurgerycapetown.co.za
  2. 2. 2 Disease of mankind • Effects most of people • 3 groups • Lower back > neck Back pain
  3. 3. 3 Complex anatomy & function
  4. 4. 4 Acute back or neck pain • Most common • Axial spinal pain • No nerve root symptoms • Muscle strain • Segmental sprain (facet joint , disc) • Pinched nerve – local irritation
  5. 5. Preventio n 5 Acute back or neck pain 90% settles within 6 weeks Non surgical treatment 1. Medication oNSAIDs oAnalgaesics oMuscle relaxants oSometimes as inpatient 2. Physiotherapy oExercise program oAcupuncture, TENS 3. Modification of activities oRest / bed-rest / traction oEarly mobilization
  6. 6. Investigations X-rays CT / MRI scan Blood tests Presentation out of ordinary •Age - < 20 yrs or > 60 yrs •Red flags – trauma, tumour, infection •Radicular symptoms, neurology (incontinence, weakness, absent reflex) •Ongoing / chronic pain – no response to conservative Rx Spinal pathology
  7. 7. 7 Common spinal pathology Cervical and Lumbar DiscDisc ProlapseProlapse Spinal StenosisStenosis DegenerativeDegenerative Disc DiseaseDisc Disease Neural compressionNeural compression • Protection of neural elements
  8. 8. 8 Common spinal pathology Spinal InstabilityInstability • Supporting structure for the skeleton FracturesFractures • trauma • pathological DegenerativeDegenerative (spondylolisthesis)
  9. 9. 9 Non surgical treatmentNon surgical treatment No or mild neurology, instability Restore functionRestore function 1. Medication oNSAIDs oAnalgaesics oMuscle relaxants oSometimes as inpatient 2. Physiotherapy oAcupuncture oExercise program 3. Modification of activities oRest / bed-rest / traction oEarly mobilization 4. Caudal epidural cortisoneCaudal epidural cortisone oGood results
  10. 10. Surgical treatment options Neural compression •Disc Herniation •Spinal Stenosis •Degenerative Disc Disease DecompressionDecompression •creating more space and freeing the nerves and spinal cord DiscectomyDiscectomy •removing herniated disc Techniques Laminectomy Laminotomy Foraminotomy or a Combination of the above procedures Spinal instability •Fractures •Tumours •Post surgery Spinal fusionSpinal fusion •one or more of the vertebrae of the spine are united together (“fused”)  Bone graft only or with Instrumentation  Posterior or Anterior  or a Combination of the above techniques
  11. 11. Spine Surgery - New AdvancesNew Advances Minimally invasive spinal surgeryMinimally invasive spinal surgery •RhizotomyRhizotomy •Kyphoplasty or vertebroplastyKyphoplasty or vertebroplasty Cervical disc replacementCervical disc replacement Minimal Access Lumbar SurgeryMinimal Access Lumbar Surgery •Discectomy, decompressionDiscectomy, decompression •Interbody fusionInterbody fusion • TLIF, DLIFTLIF, DLIF •Pedicle screw instrumentationPedicle screw instrumentation
  12. 12. New AdvancesNew Advances Radio-frequency rhizotomyRadio-frequency rhizotomy • Minimally invasive surgical technique • Limited application
  13. 13. New AdvancesNew Advances Balloon kyphoplastyBalloon kyphoplasty •minimally invasive surgical technique •treat vertebral compression fractures •caused by osteoporosis, spinal injury
  14. 14. New AdvancesNew AdvancesAnterior cervical fusion vsAnterior cervical fusion vs.. Cervical disc replacementCervical disc replacement Cervical disc prolapse or degenerative Dx •intractable neck and/or arm pain •herniated disc or bony spurs (osteophytes) Neck trauma – fractures / dislocations • Preservation of motion • Protection of the neighbouring levels from accelerated wear and tear • Younger patients Anterior Cervical DecompressionAnterior Cervical Decompression andand Fusion Cervical disc replacementCervical disc replacement • Classic operation -great results • Iliac graft – morbidity • Adjacent segment Dx
  15. 15. New AdvancesNew AdvancesAnterior cervical fusion vsAnterior cervical fusion vs.. Cervical disc replacementCervical disc replacement
  16. 16. New AdvancesNew Advances Minimal Access Spinal TechniquesMinimal Access Spinal Techniques (MAST)(MAST) Conventional spinal surgery •Larger skin incision •Muscle stripping / cutting •Damage to structures •More post-op pain, longer stay Minimally invasive spinal surgeryMinimally invasive spinal surgery •Small incision •Tubular device provide the working channel •Muscle splitting / spreading – less damage •Less post-op pain, shorter hospital stay •Quicker functional recovery  MAST-ering technique – expertise, learning curve  Special equipment  Selected cases
  17. 17. NewNew AdvancesAdvances Minimally invasive lumbar discectomyMinimally invasive lumbar discectomy Conventional discectomy •Remove herniated disc •Laminectomy or laminotomy Micro discectomyMicro discectomy
  18. 18. New AdvancesNew Advances Spinal fusionSpinal fusion Conventional fusion Combined fusion techniquesCombined fusion techniques • two or more of the vertebrae of the spine joined together (“fused”) so that motion no longer occurs between them •Lumbar Interbody fusionLumbar Interbody fusion • PLIF - posterior • TLIF - transforaminal • DLIF – direct lateral • Postero – lateralPostero – lateral fusionfusion • Pedicle screwPedicle screw instrumentationinstrumentation • Anterior interbodyAnterior interbody fusionfusion
  19. 19. New AdvancesNew Advances Minimal access lumbar fusionMinimal access lumbar fusion
  20. 20. New AdvancesNew Advances Minimal access lumbar fusionMinimal access lumbar fusion DLIF – direct lateral interbody fusionDLIF – direct lateral interbody fusion
  21. 21. Right patient selection Successful surgerySuccessful surgery
  22. 22. Successful surgerySuccessful surgery Clinical findings •Acute leg pain •S1 nerve root (EHL, TA reflex) Investigations Failure of conservative Rx Right surgery •discectomy
  23. 23. Successful surgerySuccessful surgery Clinical findings •Leg and back pain •Spinal claudication Investigations Failure of conservative Rx Right surgery Decompression + fusion Limited decompression
  24. 24. Second opinion
  25. 25. Thank you

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