SPINE SURGERY

The spine consists of bone fragments called vertebrae, located between the skull and the coccyx. Between the vertebrae, which are in a symmetrical arrangement, there are disc and facet joints. These joints provide mobility to the spine while increasing its strength and flexibility. The tissue in the front of each vertebra is called the disc and the one in the back is called the facet joint. The soft tissues between this structure, which extends from the skull to the coccyx, also protect the spinal cord which is an important part of the central nervous system by surrounding it. The spinal cord, like the brain, is surrounded by a membrane called the meninges. There is cerebrospinal fluid between the continuation of the cerebral cortex and the spinal cord. The spine, which forms the basis of the human skeleton, consists of 7 cervical vertebrae, 12 thoracic vertebrae, 5 vertebrae, and 5 sacral vertebrae. The spine is also supported by connective and muscle tissues, which are defined as “ligaments” in medicine. Thanks to all this anatomical structure, the spine has a solid and movable structure. Disorders due to a congenital or acquired spine can severely reduce the quality of life of the person by limiting the movements frequently performed in daily life, such as standing, turning to the right and left and moving. The treatment of common diseases such as herniated discs, lumbar spinal stenosis, spondylolisthesis, neck hernia and disorders caused by spinal trauma is performed by spine surgeons.

What is Spine Surgery?

Spine surgery is the department that deals with diseases related to the spine, which consists of the vertebrae and contains the spinal cord. These problems which can be structural, functional or mechanical, can prevent the person from doing their daily activities. Physicians who specialize in orthopedics and traumatology or neurosurgery after 6 years of medical school education specialize in this field by receiving additional spinal surgery training. Spinal cord surgeons working in a multidisciplinary manner with other disciplines such as physical therapy, rehabilitation and neurology, after making the diagnosis with the examination and additional tests performed in line with the patient’s complaints, arrange treatment for the disease and the individual. Spine surgery is mostly seen in childhood for scoliosis and kyphosis; in adults, for hernia formations and degenerative ailments; and it deals with diseases such as osteoporosis in old age.
Some of the diseases that spine surgeons treat are listed under the following headings:

Herniated Disc

Lumbar hernia can be defined as the protrusion or herniation of the disc, which is located between the vertebrae and acts as a cushion, between two vertebrae. Under normal conditions, each disc consists of a solid outer layer called the annulus fibrosus. In the middle of the disc, there is a gel-like structure that gives it its cushiony character. The gel structure in the middle of the disc loses its feature and becomes unable to function as we age or the outer tissue of the disc, known as the annulus fibrosus, cracks. The disc protruding from the vertebrae causes back and leg pain as well as weakness in the feet and legs. Different treatment methods can be applied according to the severity of the lumbar hernia. While some cases improve with medication and exercise, in some cases, surgery is required to relieve the pressure of the herniated disc on the nerve.

Lumbar Spinal Stenosis

Popularly known as “stenosis” or “lumbar canal stenosis”, this is one of the most common complications of spinal surgery. Lumbar spinal stenosis is mostly seen due to the decrease in the amount of fluid in the disc structures located between each vertebra due to advanced age. Due to this deformation, the discs harden and shift from their current position toward the spinal canal. Sometimes the facet joints between the vertebrae are also exposed to the same process, causing narrowing of the canal structure. Depending on the narrowing of the canal, pressure is applied to the nerve root. In this case, symptoms such as cramps, numbness and pain in the back or legs occur. Complaints increase with prolonged standing and walking. In some cases, it can also lead to complaints such as weakness in the legs. If the person applies to the doctor with these complaints, the physician requests additional radiological examinations after performing a physical examination. After imaging with X-ray, MR or CT, the stenosis in the spine is determined definitively. In cases that are too advanced to benefit from drug or spinal injection treatment options, or in patients with progressive leg weakness, bladder or bowel problems, surgical intervention is performed. With this process, known as lumbar decompression, the existing pressure is removed and the canal diameter is expanded again. Another surgical option is laminectomy. In this method, the canal can be expanded by removing the relevant bone structure. After the operation which is performed according to the type of stenosis and the severity of the pressure, leg pain and loss of function in the leg are eliminated.

Spondylolisthesis

Due to this movement of the vertebrae, which slides forward or backward for different reasons, the soft tissues, spinal cord and nerves in between are compressed. While the medical term for this condition is spondylolisthesis, it is commonly referred to as “waist slippage” by the general public. Depending on the severity of the slip, the tissue, spinal cord and nerves between the vertebrae are compressed, causing complaints such as low back pain, pain in the hips and legs, tingling, burning and numbness. In advanced cases, it can also cause complaints such as severe pain in the arms and legs, urinary incontinence and paralysis. Although lumbar slippage is mostly seen due to genetic predisposition, it can also occur due to advanced age, lifestyle factors and traumas. The slippage, which is mostly seen between the L5 and S1 vertebrae, can also be caused by the weak tissue between the two vertebrae. After the person applies to the doctor with such complaints, the physician takes the patient’s anamnesis in detail and performs a physical examination. When the physician deems it necessary, he clarifies the diagnosis of spondylolisthesis by performing additional radiological imaging. Treatment options are evaluated according to the type and severity of the disease. In some cases, medication or physical therapy is sufficient, while in others, surgery is required. The nerves that are suppressed by the operation are relieved and the spine is fixed when necessary.

Spinal Trauma

Injuries to the vertebrae caused by falling, hitting, work, home and traffic accidents are defined as “spinal trauma.” Depending on the severity of the trauma, many different discomforts, such as vertebral fracture and slippage may occur. Disorders due to spinal trauma that can affect vital functions are operated on by spine surgeons with different techniques depending on the size and severity of the trauma. It is aimed at fully restoring motor and sensory functions. Physical therapy and rehabilitation are often required after surgery.

For a good life, do not forget to have your health checked regularly.