Motion Preservation Surgeries
The primary objective of motion preservation surgeries is to maintain normal or near-normal levels of movement in the spine while reducing complications and the need for a second surgery. Near-normal mobility of the spine is maintained by decompressing spinal nerves, stabilizing the vertebrae and balancing vertebral alignment. Motion preservation surgeries attempt to closely replicate normal spinal biomechanics. This is more complicated in the spine than in the joints as the functional unit of the spine is more complicated.
Instrumented Fusion Surgeries
Instrumented spinal fusion surgeries are a set of procedures in which the surgeon uses instruments such as plates, rods and screws to fuse the vertebrae back together. It is performed on adult and paediatric patients with spinal trauma, degenerative spinal diseases or deformities like a scoliosis or kyphosis. The objective of the instrumented fusion is to create a “bone bridge” connecting the segments of the spine above and below the injury. To create this “bridge” the surgeon places bone grafts along the injured portion of the spine.
The instruments used in instrumented spinal fusion procedures are made of titanium, stainless steel or cobalt chrome. The implants provide immediate strength and stability, but will not continue to keep their strength long-term. Long-term spinal stability is achieved by good fusion of the bone grafts over the length of the injury.
Minimally Invasive Spine Surgery (MISS)
Minimally-invasive Spine Surgery (MISS) is a type of spinal surgery performed using a series of smaller incisions compared to traditional open surgery. This method causes less harm to surrounding tissue and results in less pain and a quicker recovery. Minimally invasive spinal surgeries are performed using tubular retractors. The tubular retractor is inserted in the incision, and creates a “tunnel” to the affected region of the spine, through which other surgical instruments can reach the targeted area.
- Minimally invasive - Transforaminal Lumbar Inter body Fusion (MISS-TLIF) - Transforaminal Lumbar Inter body Fusion is a technique of spinal fusion, performed through micro—incisions in the sides of the spine that align with the Foramen, where the nerves exit the spine and travel to other parts of the body. This technique is primarily used to stabilize the spine and relieve pressure on the spinal nerves.
- Oblique Lumbar Inter body Fusion (OLIF) - An Oblique Lumbar Inter body Fusion is performed to correct issues caused by degeneration in a spinal disc. The surgeon carefully removes the damaged disc, and implants an inter body device in its place. The inter body device is packed with a bone graft, and it lifts the vertebrae into proper position and alignment. Then additional instruments such as plates, rods and screws are used to stabilize the spine. As the patient heals, a solid bone fusion forms over the inter body device and the instruments. The oblique lateral approach to the spine enables placement of a large inter body graft on the strongest part of the vertebrae.
- Anterior Lumbar Inter body Fusion (ALIF) - Anterior Lumbar Inter body Fusion is a spinal surgery that takes an anterior (front) approach through the abdomen. The procedure can be performed using minimally invasive techniques. The anterior approach allows the surgeon to remove the degenerative disc completely and place the interbody graft in compression, resulting in better fusion.
Open Spine Surgery
Open spine surgery is a traditional approach to spinal surgery, where the surgeon operates through a large incision in the back or abdomen. The surgeon creates an incision and retracts the surrounding muscles to gain direct visualization of the spine. While minimally invasive techniques have gained popularity in recent years due to quicker recovery time and fewer co-morbidities, the open approach is still required to perform procedures that cannot yet be performed with minimally-invasive techniques.
- Pedicle Screw Fixation - A pedicle screw is a spinal implant used to grip different spinal segments together. The screws act as anchor points that can be connected with a rod. The rods temporarily stabilize the spine. The surgeon also implants spinal grafts that will grow around the injured spine segments. This is known as spinal fusion. An inter body fusion is performed typically when there is disc herniation. The herniated disc is removed and an inter body cage with bone grafts is inserted and placed in its position. The bone graft gains strength and creates the spinal fusion.
- Transforaminal Lumbar Inter body Fusion (TLIF) - Transforaminal Lumbar Inter body Fusion is a spinal fusion surgery performed via a 6-inch incision in the lower back. It is performed to remove a degenerated spinal disc and repair it with an inter body cage fused with a bone graft. This technique is primarily used to stabilize the spine and relieve pressure on the spinal nerves.
- Anterior Lumbar Inter body Fusion (ALIF) - Anterior Lumbar Inter body Fusion is a spinal surgery that takes an anterior (front) approach through the abdomen. The procedure is performed through a 3 to 5-inch incision in one side of the lower abdomen and the abdominal muscles are retracted to access the spine. The anterior approach allows the surgeon to remove the degenerative disc completely and place the inter body graft in compression, resulting in better fusion.
Spinal Deformity Correction
Spinal deformity correction surgeries are complicated procedures with a high complication rate. This is due to the unique approach and delicacy each case requires. A spinal deformity is any variation in shape or structure of the spine, when compared to the typical form. Scoliosis is an abnormal sideward curvature of the spine while Kyphosis is an abnormal forward bending of a section of the spine. Often there may be a combination of scoliosis and kyphosis in a patient.
Paediatric Spinal Deformities
Children may experience a range of spinal deformities such as scoliosis, kyphosis, and spondylolisthesis. Common symptoms of paediatric spinal deformity include asymmetrical appearance of trunk, walking with a “waddle” or the growth of a “hunch-back” or sometimes pain. Paediatric spinal deformities require delicate and skilled treatment and correction.
Growth rod - Shilla
The Shilla technique is beneficial because it allows the spine to grow naturally, while still correcting the trauma or misalignment. The Shilla is like a track-and-trolley system. The implant rods are partially fixed to the spine segments, allowing the implant to “grow” with the spine. As the spine grows and lengthens, the rods are intended to break. Once the rods break, the patient may be fitted with a new Shilla or be recommended a spinal fusion procedure.
MAGEC rods - Magnetic growing rods
MAGEC rods are Magnetic Expansion Control Rods used in the treatment of spinal curvatures, in very young children. The MAGEC system combines the idea of traditional growing rods with an extendable, magnetic technology. With traditional rods, the paediatric patient would outgrow it very quickly, requiring revision surgery every 6-12 months. However, that is avoided with MAGEC rods. The MAGEC rods are made of magnets, with a built-in motor that allows extension to occur. The doctor uses a powerful external magnet to control the MAGEC rods in the patient’s spine, extending it as needed.
Navigation assisted spine surgery
Navigation assisted spinal surgery is a group of technologies which allow the surgeon to obtain real-time scans and 3D imaging of the spine to enable the correct location of the surgical instruments. The goal of navigation assisted spine surgery is to provide the surgeon with as much visualization as possible to increase accuracy of the surgical intervention. With a sensitive organ like the spine, this is path-breaking. The benefits of this technique include safer and more accurate surgical interventions and reduced surgery time.
3D printing has revolutionized medical prosthetics. 3D printing technology allows the surgeon to design a prosthetic that perfectly fits the patient. 3D printed implants are especially useful in the treatment of spinal deformities, where each deformity is unique. In such cases, reconstruction using standard implants is difficult.
Intra Operative Neuromonitoring
Intra Operative Neuromonitoring (IONM) is the use of electrophysiological methods like EEG, EMG etc. to monitor the function of integral neural structure like the spinal cord, important nerves and parts of the brain during surgery. Intra operative neuromonitoring reduces the risk of damage to the nervous system during surgery, and helps surgeons get better visualization and real-time patient-status.
Spinal Cord Stimulator
Spinal cord stimulator is a biomedical device implanted in the spine that emits low-level electronic signals to relieve pain. The implant is controlled by an external remote that the patient can use when they feel pain. Many patients describe the sensation of the spinal cord stimulator as a slight tingling sensation that replaces the pain. Spinal cord stimulators are usually recommended to patients with severe back pain, for whom conservative, non-surgical treatment options have not produced significant relief. Spinal cord stimulators can greatly improve a patient’s quality of life and reduce dependence on pain medication.
Complex Spinal Tumour Surgeries
Spinal tumours are abnormal growths of tissue in the spinal column. Tumours in the spine may be malignant or benign. Depending on the location and nature of the tumour, the treatment may include chemotherapy, radiation therapy and surgical removal of the tumour. Surgery is usually recommended if spine stabilization is needed or if there is nerve compression. The surgeon may perform a partial or complete tumour resection. Once the tumour is removed, the surgeon may use a spinal fusion to stabilize and reconstruct the spine.