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Spine Surgery Fundamentals
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Spine Surgery Fundamentals
Spine Surgery Fundamentals
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1
Question
What is the typical first option for treating patients with spine pathologies?
Answer
Non-operative treatment, which includes rest, medication, physical therapy, chiropractic treatment, and/or epidural or facet injections.
2
Question
Under what conditions may surgical intervention be considered in spine treatment?
Answer
If there is no improvement within six weeks or if the patient's symptoms worsen with treatment.
3
Question
What are the goals of surgical treatment for spine pathologies?
Answer
The goals of surgery are to gain atraumatic access, relieve symptoms typically through decompression, restore alignment, and achieve stability.
4
Question
What is direct decompression in spine surgery?
Answer
Direct decompression involves physically uncovering the neural element (nerve root, spinal cord) by removing any material (disc, ligament, or bone) that is directly impinging upon it.
5
Question
What is the most common form of decompression?
Answer
A discectomy.
6
Question
What is indirect decompression?
Answer
Indirect decompression enlarges the space around the spinal cord or nerve roots through realignment of structures connecting to the elements that are causing impingement.
7
Question
What procedure is primarily used to treat central stenosis?
Answer
A laminectomy.
8
Question
What does a laminectomy involve?
Answer
The removal of the lamina and spinous process to give more room for the spinal cord.
9
Question
What are the risks following a laminectomy?
Answer
Dural tears, infection, and increased pain.
10
Question
What is a hemi-laminectomy?
Answer
A procedure in which the surgeon removes only a portion of the lamina to create more space in the spinal canal and release nerve tissue from pressure.
11
Question
What is a laminotomy?
Answer
A procedure that removes part of a lamina of the vertebral arch to decompress the corresponding spinal cord and/or spinal nerve root.
12
Question
What is a laminoplasty?
Answer
The removal of the lamina on one side and the creation of a hinge on the other to increase space in the spinal canal while preserving posterior structures.
13
Question
What is a foraminotomy?
Answer
An enlargement of the intervertebral foramen to alleviate localized compression around the nerve roots.
14
Question
What does a discectomy involve?
Answer
Removing a portion of an intervertebral disc that is placing direct compression on the spinal cord and/or nerve root.
15
Question
What is a corpectomy?
Answer
A procedure where some or all of the vertebrae may need to be removed when disease affects the disc as well as the vertebral body.
16
Question
What is the goal of spinal fusion?
Answer
For bone to grow across the diseased segment.
17
Question
What is essential for fusion to occur in spinal surgery?
Answer
The soft tissue must be stripped away from the bone and the cartilage/cortical bone removed to expose bleeding cancellous marrow.
18
Question
What role does instrumentation play in spinal fusions?
Answer
Instrumentation improves fusion rates and can take many forms depending on the approach.
19
Question
What are common types of instrumentation used in spinal fusion?
Answer
Pedicle screws and rods, with anterior and lateral constructs typically including a plate.
20
Question
What factors increase the risk of non-union in spinal surgery patients?
Answer
Osteoporosis, diabetes, smoking history, and overall poor health.
21
Question
What is the risk of spinal fusion in terms of motion?
Answer
Fusion decreases spinal flexibility and may cause stress of the fused segment to transfer and concentrate on adjacent vertebrae.
22
Question
What is Anterior Cervical Discectomy and Fusion (ACDF)?
Answer
A procedure where the affected disc is removed, and the two vertebrae are fused with a spacer filled with bone graft, often secured with a plate.
23
Question
What is a risk associated with ACDF?
Answer
Difficulty swallowing post-operatively, potential vascular injury, or esophageal/trachea injury.
24
Question
What does Posterior Cervical Fusion involve?
Answer
Removal of the lamina and bone spurs, with screws or hooks and rods used to hold the spinal column in place while fusion occurs.
25
Question
What is cervical arthroplasty?
Answer
A procedure where the defective disc is replaced with an artificial one, allowing the patient to maintain motion.
26
Question
What are risks associated with cervical arthroplasty?
Answer
Allergic reaction, neck or arm pain, difficulty swallowing, and nerve injury.
27
Question
What is the purpose of a Posterior Lumbar Interbody Fusion (PLIF)?
Answer
To address conditions such as spondylolisthesis, degenerative disc disease, or disc herniation.
28
Question
What are the typical risks of PLIF?
Answer
Failure of fusion, possible adjacent level degeneration, and nerve injury.
29
Question
What is the difference between PLIF and TLIF?
Answer
TLIF uses a unilateral approach and requires less muscle dissection and bone removal compared to PLIF.
30
Question
What is the primary advantage of Anterior Lumbar Interbody Fusion (ALIF)?
Answer
The larger footprint cage placed due to uninterrupted access to the disc space.