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Monday, 23 October 2017
Spinal Procedures

The Spinal Unit undertakes a full range of spinal procedures, including:

Nerve Root Blocks

Nerve root pain can result from irritation of the nerve from a disc prolapse or bony irritation. This presents as leg pain from the lower back.

Nerve root blocks are performed as a day case procedure. They can be used as a diagnostic injection as well as giving good therapeutic relief in many cases. In a large number of patients this may avoid the need to undergo a major operative procedure. The injection uses local anaesthetic and steroid to help settle any inflammation around the nerve.

In some cases the symptoms may return and a further injection or an operation may be required to give a permanent solution.

Facet Joint Injections

There are a pair of facet joints at each level of the spine. These joints can undergo degenerative changes  and can lead to pain.

Symptoms can lead to a reduced range of movement and pain. This tends to be exacerbated by extending and rotating the back. This condition is most common in patients over the age of 55 years.

Injections into the facet joints are performed as a day case procedure. This involves the Injection of local anaesthetic and steroid into the joints. This can be performed at several levels at one time.

These injections can give good relief for a period of time. Repeat procedures can be performed.

Lumbar Discectomy

This procedure is usually performed to treat sciatica or radicular symptoms. The affected nerve root is in most cases compressed by a disc herniation. The vast majority of patients feel significant benefit in regards to relief of their pain.

The procedure involves a small incision over the level of the disc. After moving the spinal muscles out the way, some bone and ligament flavum is removed to gain access to the spinal canal. The affected nerve is mobilised away from the the disc prolapsed. The loose disc material is removed to create room for the affected nerve.

This procedure involves an average hospital stay of approximately 1-2 nights. Most people are able to mobilise the following day.

Lumbar Decompression

The procedure is similar to a lumbar discectomy. In most cases the condition is due to thickening of the ligamentum flavum and facet joint hypertrophy. The procedure therefore requires removal of slightly more bone. The excess bone and ligament is removed to give the compressed nerve more room. In most cases the  leg pain tends to respond to this treatment over a few weeks. Residual numbness or weakness can take several weeks or months to recuperate.

This procedure involves an average hospital stay of approximately 2-3 days. Most people are able to mobilise the following day.

Lumbar Fusion (Non-Instrumented Fusion, Posterior Lumbar Instrumented Fusion, Transforaminal Lumbar Interbody Fusion, Anterior Lumbar Interbody fusion)

Lumbar fusions can be used to treat a variety of conditions, including chronic lower back-pain. This can only be performed in a few selected cases. In the majority of cases this will be perfomed using an anterior approach.

Fusion can also be performed to stabilise an unstable segment of the spine, also known as spondylolisthesis. This will in most cases be done from the posterior approach. In some cases screws and rods will be placed in the spine. This is not always be necessary.

In a variety of cases a cage will have to be inserted. This is known as an interbody fusion. This can be performed from the anterior or posterior approach. The approach will be determined by the pathology.

Post-operative physiotherapy is important to maintain mobility and strengthen up core stability muscles.

Anterior Cervical Discectomy and Fusion

An anterior approach to the cervical spine may be necessary to decompress the nerve roots or the spinal cord.

The approach is performed through a transverse incision on one side of the neck . The oesophagus and larynx are moved away from the front of the spine. This allows access to the discs in the cervical spine. The disc can then be removed to fully decompress the spinal cord and the nerves. The space left behind is then filled with either a cage with bone graft or a disc replacement.

A drain is inserted and then removed the following day.

Posterior Cervical Decompression / Fusion

In some cases it may be felt that the best way to decompress the spinal cord is by use of a posterior approach. This is usually in cases where multiple levels have to be decompressed or the main compression on the spinal cord is from the back. This is usually due to thickening of the ligamentum flavum.

The posterior approach involves dividing the muscles on the back of the neck and tends to be more uncomfortable. In some cases stabilisation of the spine may also be required by use of screws and rods.

Procedures for Spinal Trauma

Spinal fractures and  can be treated in many ways. In some cases it may be appropriate for your injury to be treated by conservative measures. In other cases it may be appropriate for you to undergo a spinal operation.

If an operation is considered this can be performed in two main ways. The first method involves a posterior approach and fixation with screws above and below. The second method is anterior approach and reconstruction of the spine.

Treatment depends upon the nature of the injury and its location in the spine.

Procedures for Spinal Tumour

Tumours can affect the mechanical stability of the spine as well as compression of the neural elements. The aims of surgery are to decompress the nerves and the spinal cord. Following this the spine can be stabilised using either an anterior or posterior approach.

Surgery for tumours in the spine are often due to spread from another site. We offer a joint service for such cases with the Oncology Department. In some cases surgery may not be appropriate and your case may be best managed by the Oncology team.