Neurosurgery
Spine Diseases
Disc Herniation:Softening of the cartilage ring (disc) between spinal vertebral bones degenerate with time causing collapse and softening. This can result in a portion of disk moving outwards and pressing on nerves. The result of this is pain that extends down the leg or arm, numbness or tingling, and/or weakness.
Treatment is usually with medications for pain relief but if progressive weakness or significant weakness is present or if pain is not relieved with medication or if after 2-3 months of medication treatment, the pain persists, surgery is generally recommended. For the neck, the procedure usually involves a small incision on the right side of the front of the neck with removal of the disc and fusion of the bones above and below with a bone graft with or without a titanium plate. For the spine, most commonly, a 2-3 centimeter incision is made in the midline of the back and the disc piece removed after separation of the tissues. These procedures are known as "Discectomies".
Patients generally go home the following morning after surgery but many with lumbar disc surgery will go home the same day of surgery as "Daycare" patients.
Spinal Stenosis
As a result of disc disease, arthritis develops in the spine over time, resulting in narrowing of the space for the spinal nerves and spinal cord. This can result in pain down the legs, particularly with activity, as well as weakness and loss of sensation.
In the lower spine, treatment involves a procedure called a "laminectomy". Here, a longer incision in the midline of the back is required to unroof the nerves and allow for decompression. Occasionally, a fusion of the bones is required. This is discussed under "Instability". In the cervical spine, spinal stenosis can be treated by decompressing discs, much as like is done for disc herniations from the front of the neck. A laminectomy can also be performed from the back of the neck.
Following surgery for spinal stenosis, patients stay in hospital for 1-3 days for lower spinal operations and usually go home the following day for neck operations.
This is defined as abnormal movement of the spinal bones or ligaments resulting in pain, deformity, or loss of function from neurologic compromise. It can result from disc disease, fractures or other forms of trauma, infections, tumours, or developmental problems.
Treatment generally involves fusing the bones with or without decompression of the spinal nerves or spinal cord. Fusing refers to the linking of bones together and removal of movement at the level of the abnormal movement. It can be accomplished by placing bone at the joints, with or without metallic hardware such as rods, screws and plates.
Minimally Invasive Neurosurgery
As with many types of surgery, the trend has been towards lesser invasive forms of surgery with potential for reduced physical repercussions, reduced complication rates and improved outcomes. Some of the techniques available are listed below as well as the respective diseases that can be treated with them.
Endoscopic Spinal Surgery:
- Discectomy
- Spinal Fusion
Kyphoplasty and Vertebroplasty
These treatments are used commonly in cancer patients and elderly patients with compression fractures of the spine resulting in weakened bones or pain.
These treatments involve the placement of a needle through the skin in the back into a osteoporotic compression fracture site or into a site of a fracture because of a tumour involving the spine. Then acrylic cement is placed into the broken or weakened bone allowing the level to be stabilized allowing pain to be improved and preventing future fracture.