Spinal Surgery, Here's What You Need to Know

Spine surgery is a surgery on the spine that usually aims to treat spinal or back pain. The type of spinal surgery performed depends on the type of illness suffered by the patient. The spine consists of 33 vertebrae, with the 24 top vertebrae separated one by one, which make up the spinal sequence from top to bottom. Between each vertebra, there are cartilage pads called spinal discs. In the middle of each spinal segment has a hole, so that between the holes with one another to form a channel filled with spinal nerves along the spine. Spinal surgery is a medical procedure that is usually performed after other treatments have not succeeded in relieving spinal pain. In addition to relieving pain, spinal surgery can also overcome complaints that occur in one or both arms or legs, which are caused by spinal cord disorders. Treatment methods that can be recommended for patients with spinal disease before surgery include:

• Break
• Giving medicine
• Physiotherapy
• Use brace or support

If this treatment method is not effective in relieving spinal pain, then new patients are recommended to undergo spinal surgery. The type of spinal surgery performed will depend on the type of illness suffered by the patient.

Types of Spinal Surgery

Based on the technique, there are many types of spinal surgery. However, in general spinal surgery can be divided into 2 types, namely decompression surgery and stabilization surgery. Both decompression surgery and stabilization surgery aim to relieve pain and paralysis due to disorders of the spinal cord. Decompression surgery aims to relieve pain due to spinal cord disorders by removing the part of the spine that compresses the spinal nerves. While stabilization surgery aims to relieve pain by stabilizing the position of the spine to prevent the re-emergence of pressure on the spinal nerves. If needed, decompression and stabilization operations can be done together in one operating procedure. Spinal surgery using decompression techniques, including:

• Laminotomy. This procedure aims to reduce the pressure on the spinal cord by cutting a portion of the lamina, which is the back of the spinal column, so that the pressure on the spinal cord can subside.
• Laminectomy. It is almost the same as laminotomy, but in laminectomy the entire lamina of the spine will be removed. Laminectomy can help reduce inflammation due to pressure on the spinal nerves, although it is not immediately felt after this procedure.
• Discectomy. This procedure aims to relieve pressure on the spinal cord due to the abnormal shape of the spinal discs and experience herniation or protrusion (hernia nucleus pulposus). Disectomy is done by cutting the spinal discs, so that there is more space for the spinal nerves and the pressure on the nerves will decrease by itself. Dectectomy can be combined with laminectomy for maximum results.

Spinal surgeries that use stabilization techniques, include:

• Spinal Fusion. This procedure is done by regulating the composition of the spine, then uniting the actual vertebrae apart, to prevent movement that can cause pressure on the spinal nerves. Spinal fusion can also be done after decompression surgery to prevent back pressure on the spinal cord.
• Vertebroplasty. This procedure is done by injecting a substance such as cement into the fractured part of the spine.
Injecting substances such as cement is to make the spine more stable and restore the shape of the spine to its original state.
• Kifoplasti. Just like vertebroplasty, kifoplasti is also done by injecting semen into the part that has broken vertebrae. But before being injected with cement, the part that has broken the spine will be widened with a special balloon.

Indications for Spinal Surgery

Spinal surgery is mostly not an emergency medical procedure. However, you should immediately consult an orthopedic doctor or neurosurgeon to plan whether surgery is needed, if the following happens:

• Pain that does not subside or worsen after two weeks.
• Stiffness or tingling in the arms or legs.
• There are weaknesses and loss of function of arm or leg movements.
• Fever.

These symptoms can be a sign of a disease that requires spinal surgery, such as:

• Spinal stenosis.
• Myelopathy or abnormalities in the spinal cord.
• Spinal damage or displacement.
• Tumors of the bones or spinal nerves.
• Spinal infection or spinal cord.
• Shift or thinning of the spinal cushions.

Spinal Operation Warning

Not all people with spinal disease can undergo spinal surgery. In addition, each spinal surgery technique has different requirements. In general, there are no absolute conditions that cause a person unable to undergo decompression surgery. However, spinal decompression surgery should be avoided if the patient:

• Have kyphosis.
• Still children.
• Not undergoing maximum non-surgical therapy.

As for spinal stabilization surgery, it should be done with extreme caution if there are:

• Osteoporosis.
• Severe injury to the protective layer of the spinal cord (epidural).
• Malignant tumors, especially in the spine.
• Spinal fracture.
• Infection.

Preparation of Spinal Surgery

Before spinal surgery, the patient will undergo a general health examination to ensure his condition is ready for surgery. The patient must inform the doctor about:

• Medicines that are being consumed, including vitamins, supplements, and drugs that can be purchased freely.
• Drug allergies, especially allergies to drugs.
• Being pregnant or planning to become pregnant.

A few days before undergoing surgery, patients will be asked to stop smoking and stop taking blood-thinning drugs. The patient must also fast for several hours before the operation begins. If the patient has thick hair around the operating area, it will be shaved first. Patients will also undergo additional examinations before undergoing surgery, such as blood tests, X-rays, or MRI to provide additional information related to the condition of the spine that will undergo surgery.

Spinal Surgery Procedure

Patients will be asked to change clothes with special clothes and take off the jewelry worn, then taken to the operating room. After that, the patient is given a general anesthetic so that he will not be conscious during spinal surgery, and is positioned according to the type of surgery, usually on his stomach. When the patient is unconscious, the doctor will start making incisions or skin incisions in the area of ​​the spine to be operated on. Incisions can be made in the neck, upper back, lower back, or abdomen so that the spine can be operated from the front. The size of incision made can vary according to needs. After the incision is made, the doctor will then perform decompression or stabilization of the spine. In decompression surgery, the doctor will remove the part of the spine that causes pressure on the spinal cord. The doctor can remove the spinal segments (vertebrae) or the spinal segment bearings that cause pressure on the nerves. During decompression surgery, the doctor can also correct the position of the depressed spinal cord by regulating nerve fibers to return to the spinal cord. The spine and spinal cushions that are the target of decompression surgery are often not completely removed, but only removed in parts that cause nerve compression. Whereas in stabilization surgery, after an incision is made, the doctor will install a spinal balancer in each segment of the spine that has shifted. This tool is usually made of special metal which is installed using bolts directly on the spine. After that, the doctor can add a bone graft to that part of the spine to accelerate fusion or fusion between segments of the spine undergoing stabilization. This bone graft can be taken from the patient's own body or from a donor. However, in patients undergoing decompression and stabilization surgery simultaneously, bone removed in the decompression procedure can be used as a graft during the stabilization process. In some cases, bone grafts can be replaced with synthetic materials so that the integration between the spine can run faster. After all the surgical procedures are finished, the doctor will then close the operating area using a sewing thread. The operating area will also be covered with sterile bandages to prevent infection. The patient will then be taken to the treatment room to undergo hospitalization and postoperative recovery.

After Spinal Surgery

Patients will generally be hospitalized for 2-3 days. During the treatment and recovery period, patients can feel pain and discomfort in the operating area. Doctors can provide pain medication for consumption during inpatient and outpatient care. During the recovery period, both in the hospital and at home, patients are encouraged to exercise mobility or movement by walking. Generally the total recovery period of patients undergoing spinal surgery is around 6 weeks. However, the duration of this recovery depends on how severe the pain suffered and the complexity of the spinal surgery underwent. In addition to feeling pain, patients can also feel sore and stiffness in the back undergoing surgery. To train the body to perform physical activity again after the recovery period, the patient will be assisted with physiotherapy. Stitches made during surgery can use sewing threads that can blend together or those that cannot be integrated with body tissues. When using a sewing thread that is not integrated with the body, the doctor will remove the suture after the wound closes. The doctor will also schedule the patient's routine control time to monitor the recovery process during outpatient care. Patients should immediately contact a doctor if they experience symptoms of infection, such as:

• Discharge from the surgical wound.
• Fever.
• Shivering.
• Redness, swelling, or hardening of the tissue in the area of ​​operation.

Risks of Complications of Spinal Surgery

Complications that can occur after spinal surgery, include:

• Infection.
• Bleeding.
• Blood clotting.
• Pain in the bone area taken for bone graft.
• Damage to blood vessels or nerves near the operating site.
• Surgical wounds that are difficult to heal.
• Reappearance of pain in the spine after undergoing surgery.
• Tearing of the protective membrane of the spinal cord which causes leakage of cerebrospinal fluid and spinal cord.
• The face feels stiff and impaired vision.
• Paralysis.