Various Techniques to Correct Spine Injuries

Abstract

The biological advancement is rapidly expanding in the correction of spine surgical procedures. The demands of expertise are increasing in the medical field of surgeons, especially in spine surgeries. There are numerous technological developments which might be complicated to understand, the main reason for some controversies are due to unidentified stem cells involved in spine surgeries. There is a less invasive method introduces in recent years which includes graft replacement and spine fusion surgeries.

This paper summarizes the various inventive techniques used to correct spine injuries either involving cervical spine injury or thoracolumbar in children or in adults. The main process of providing surgical correction is to use a less invasive method with less postoperative pain and complications.

Introduction

The processes of providing care to the patients having spinal injuries are becoming complex day by day. This will make the medical staff more active towards the procedure in providing care to their respective patients. Therefore, it has huge spectra in managing injuries which include operative, non- operative and process of managing the pain. The first and most initial step in managing the spinal injuries is care provided by the primary care physicians. Their responsibility is to manage the pain, by providing anti-inflammatory, muscle relaxant medications are most recommended.

Although the vertebral column is made up of 33 bones which are called vertebrae, it makes the backbone of the body which provides the support to stand firm (Viezens, Helmers, Vettorazzi, Schroeder, & Hansen-Algenstaedt, 2017). There are discs in between each vertebra to reduce the friction during movements. Each vertebra has specific points for muscles and ligaments to attach in order to provide firm shape and coordinated movement.

Regions of the Spine

The spinal cord is divided into five segments:

1. The seven initial vertebrae in the upper part of the neck region which is also known as the cervical region.
2. The next twelve vertebrae are attached to the ribs on the chest area which constitutes a thoracic region
3. next five vertebrae are to provide support to the torso present at the lower back and make the lumbar region.
4. Another five vertebrae are fused together into a single bone which is known as the sacrum
5. The last four vertebrae are completely fused and take the tailbone structure called coccyx.

The basic manner by which the spine is treated are categorized into three basic routes; namely;

1. Dura matter is directly exposed an agent is applied to it, agent diffuses through dura and intrathecal space.
2. An agent is directly injected in intrathecal space.
3. Injecting the agent directly into the spinal cord.

Surgical Options

The treatment options are broadly divided into two categories: non-operative options and surgical options. The non-operative option depends on managing the pain and providing symptomatic treatment to the patient. However, the other option is surgical which is provided according to the disorders that include spinal fractures, degenerative disc diseases, and spinal deformities are treated with minimal disruptive procedures. Non- invasive procedures required a small incision to prevent the trauma and sparing techniques which will use to assist and to produce minimal blood loss and reduces the postoperative pain.

Discussion

There are exciting changes in the art of treating spinal injuries, the focus of this paper is to address contemporary techniques and equipment to practice in the modern era of spine care while surgery over the next decade. There are various diseases which include deformity, degenerative diseases, trauma, and infection. There are different techniques used for cervical spine injuries ad thoracolumbar spine injury while it is present in a child or present in the adult.

Degenerative Cervical Spine Diseases

It is the recent term which encompasses the different degenerative pathologies in which there is a damage to a bony framework of a vertebra, it includes spondylosis, degenerative disk disease, and ossification of the posterior longitudinal ligament this will result in compression of the spinal cord. This clinical syndrome is characterized by the presence of symptoms which include decreased hand dexterity, gait imbalance, and presence with possible sphincter dysfunction. The management of these diseases depends on the timing of its intervention with the ideal surgical approach.

The important procedure which is used to correct the cervical spine compression is achieved through surgical decompression approach; it is effective in moderate to severe myelopathic patients with less chance of producing serious complication. There is a slight difference in the surgical approach used in an anterior and posterior region of the cervical spine. However, it is still a controversial debate about the relative efficacy of achieving laminoplasty vs. laminectomy (Marquez-Lara, Nandyala, Fineberg, & Singh, 2014). Or either the differences in minimally invasive surgery vs. open surgery along with the adjuvant pharmacological management. Majorly, the surgical approach divides into two parts like the anterior and posterior parts of the cervical spine. Thus an anterior approach describes less disruption to the normal musculature and it is also easy to maintain the normal alignment of the spine.

An Anterior Cervical Discectomy and Fusion is the procedure used in neck surgeries. It is the procedure which involves removing the damaged disc which relieves spinal cord or nerve root pressure and lessens equivalent pain, tingling, numbness, and weakness. Hence, discectomy is the procedure of surgical decompression and this complete art of surgical repair is known as anterior cervical decompression. It is observed that this surgical approach is most commonly done to treat the patient present with the symptomatic cervical herniated disc; it is also suitable for cervical degenerative disc disease. The advantages which are obtained from ACDF are it provides direct access to the disc, so direct visualization of the cervical disc can be easily achieved. It is the process which produces less postoperative pain which makes it more compatible with the patient.

At time myelin is directly inhibited this technique is now called NOGO, this technique has been studied for years and has detailed research on it. In this mylien is inhibited. Dr. Martin Schwab from Zurich research ton this treatment by treating sharp partial transection injury by

Pediatric Cervical Spine Management

The management of the cervical spine procedure in children is quite a challenging issue. There are huge diseases which required surgical arthrodesis in a pediatric patient. The basic steps of the process are similar to the managing process of the adult. While the factors which need attention is the high osteointegration capability of a child's bone tissues that allows for stable and simple fusion after the surgical process.

Instrumentation is another aspect which needs to be carefully managed in a child. It is evident in the literature that rigid and firm instrumentation is used in a child after the age of 10 years. But from the year of three years till ten years sub laminar wirings are used. In many cervical spine cases, the surgical procedure closes and stabilizes and the level of C0 to C2 levels in 17 months old babies. The main reason to obtain this procedure is that it healed without producing any major complications. The process of bone completion is achieved within 1 year of life which is completely satisfactory (Hedequist & Emans, 2016).

Furthermore, the cartilaginous tissue in the cervical spine of babies requires the placement and insertion of screws which should be done accurately. Therefore, the surgical planning should be based on the complete and effective study of the anatomy which will be based on complete investigational process include CT scan, plain radiographs, and angiographs which will be used to assess the course and variation of vertebral artery more often present in severe vertebral deformity.

Bone grafting is another process which can be used to correct the cervical spine injuries, while it is also evident that for babies under 36 months old, combination of using bone promoter with local autograft will give suitable and satisfactory results at the time of surgery and also after the one year within surgery after fusion of the bone.

Degenerative Thoracolumbar Surgery

There are some numerous harmonizing fields of spine surgery which consists of deformity, osteobiologics, and robotics are the procedure that actively being combined to treat the upcoming generations present for the treatment of the degenerative thoracolumbar diseases. Lumbar decompression is the procedure which is used to correct the compressive thoracolumbar diseases. But it needs to be avoided in elderly patients present with substantial medical comorbidities present with pre-operative conditions. However, the risk and profit balance will be checked by using the introductive procedure of named as interspinous process spacers, endoscopic approaches, and some percutaneous instrumentation. It involves the broad inclusion criteria to be used in degenerative thoracolumbar surgery. To minimize the blood loss with fewer infection rates the techniques which can be used and achieved as insertion of intervertebral fusion cages it becomes more safer techniques achieved by obtaining less invasive transformational extraforaminal and oblique lumbar interbody fusion techniques (Scemama, Magrino, Gillet, & P., 2016).

The purpose of attaining the decompression surgery is to relieve the pain which is generated by nerve root pinching. There have two major causes for lumbar nerve root pressure; lumbar spinal stenosis and lumbar spinal stenosis. The procedure of decompression surgery involves eliminating a small portion of the bone from the nerve root area or the disc material under the nerve root which is used to relieve the pain which is continually creating a room for the nerve to heal. The most common type of decompression surgical procedure is microdiscectomy and laminectomy.

In general, the process of lumbar fusion is used to relieve pain during movement in the lower segment at the back. This is mostly done in the diseases of lumbar degenerative disc diseases and spondylolisthesis. Spinal fusion is also used to involve the bone grafting that will stop the painful vertebral motion, which ultimately helpful in reducing the pain.

Surgical Approach for Thoracolumbar Spine Surgery in Children

In children, surgical approaches should be maintained by providing special care. The most common injury present in children is idiopathic scoliosis, the most common procedure used to treat this condition is spinal fusion, and it is the process in which surgical incision is made on the spine by either using a posterior approach or an anterior approach. Whereas placement of the rods are done into the spine from the direction where the incision has been made. It is noticed that from previous years an anterior approach is much more increasingly used. The metal rod is placed in the spine from the side to provide support which is much needed in a child patient. These rods are directly attached to the vertebral bodies (Luo, Jr, D.W., Ledonio, & Larson, 2016).

Another approach which is used and refer to a less invasive method known as thoracoscopy. In this approach large incision is not needed, telescopic instrumentation is used which allowed placement of metal rods into the chest with the deflated lungs and attached to the vertebra. It requires more expertise as this is the more technical procedure. The method of inserting a growing rod is more effectively used in pediatric patients, it will provide stabilization thus it will easy to elongate the rod in every six months with non-invasive surgery in growing children. However, the new approach is designed named as stapling the spine which will use and try to modulate the growth of the spine but this technique is not approved for the general use.

Conclusion

There are different approaches used to correct the spine injuries and pathologies. The most frequent method to produce correction by using spinal fusion method. It is the process which is surgically achieved, it requires minimal incisions during the surgery. Besides that, the biological substance used as bone grafts are new techniques which are developing during the last decades. Thus, there is a various advancement in the category of spine surgery which includes spinal instrumentation, some minimally invasive technologies, vertebral prosthesis, and bone grafts. There are certain biological substances which are used in a vertebral column that induce the growth of cell and correct the demineralization, but their proper use is still controversial therefore the spinal fusion techniques are much more acceptable in accordance to relief pain either in children or presence of spinal injuries in an adult.