The Spine Unit (Spine Surgery) treats spinal diseases and injuries as part of the specialty of Brain and Neurosurgery. Surgical procedures are performed to improve spinal function and enhance patients’ quality of life. Our unit adopts a multidisciplinary approach that addresses all aspects of spinal disorders. Spinal surgery plays a significant role in treating spine-related pain and injuries and aims to improve our patients’ quality of life.
What Is Spinal Surgery?
Spinal surgery is a subspecialty of Neurosurgery. It involves surgical procedures performed to treat spinal disorders and injuries. These surgeries are performed to improve spinal function and enhance patients’ quality of life.
Spinal surgery plays a particularly important role in the treatment of spine-related pain, nerve compression, and spinal cord injuries. Surgeons in this field are professionals with a high level of expertise and experience in the diagnosis and treatment of spinal disorders. Spinal surgery, performed in both emergency and elective settings, helps patients lead healthier lives.
What Are Spinal Disorders?
Spinal disorders are various conditions that affect the structure and function of the spine. These disorders can be serious enough to require spinal surgery. The most common spinal disorders are as follows:
Disc Herniations (Neck, Back, and Lower Back Herniations): A disc herniation occurs when the discs—which act as shock absorbers between the vertebrae—slip or tear, putting pressure on the nerve roots. These herniations can occur in the neck, back, and lower back regions. While cervical disc herniations (neck herniations) affect the neck and arms, lumbar disc herniations (lower back herniations) affect the lower back, hips, and legs.
Spinal Stenosis: Spinal stenosis is a condition caused by the narrowing of the spinal canal and the resulting pressure on the nerves. It is generally associated with the aging process and can lead to pain, numbness, and weakness in the neck, arms, lower back, and legs.
Skolyoz: Skolyoz, omurganın yana doğru eğrilmesi durumudur. Genellikle ergenlik döneminde ortaya çıkar ve şiddetli vakalarda cerrahi müdahale gerektirebilir.
In addition to cosmetic concerns, scoliosis can lead to postural abnormalities, as well as back and lower back pain in advanced stages.
Kyphosis: Kyphosis is an abnormal forward curvature of the spine. Also known as “hunchback,” it typically creates a rounded appearance in the shoulders and back. It can lead to pain and limited mobility.
Spinal Infections: Spinal infections occur when bacterial or viral infections cause inflammation in the spine or spinal cord. These infections can cause severe pain and neurological problems.
Spinal Tumors: Spinal tumors are benign or malignant growths that develop in the spine or spinal cord. These tumors can damage the spinal structure and the nervous system, which may require surgical intervention.
What Are Spinal Tumors?
Spinal tumors are abnormal cell growths located in the spine and spinal cord. Like any tumor, they require a multidisciplinary approach. Radiological evaluation, oncological staging, and the need for postoperative chemotherapy or radiation therapy are planned following a thorough assessment by surgeons and oncologists. The spine unit plays a crucial role in this process.
They are divided into two main categories:
1. Primary Spinal Tumors
Primary spinal tumors originate from cells of the spine or spinal cord. These tumors are generally rare and can be benign (non-cancerous) or malignant (cancerous).
2. Metastatic Spinal Tumors
Metastatic spinal tumors are cancers that originate in another part of the body and spread to the spine. These types of tumors are more common and usually stem from cancers of organs such as the lung, breast, or prostate.
What Are the Main Surgical Methods Used for Spinal Disorders?
Various surgical methods are used in the treatment of spinal disorders. These methods are determined based on the type and severity of the condition, as well as the patient’s overall health. Spinal surgery is a frequently used approach in the treatment of spinal disorders. In our Spine Unit, the primary surgical methods used to treat spinal disorders are as follows:
Lumbar Microdiscectomy: Lumbar microdiscectomy is a procedure in which damaged or herniated discs between the lumbar vertebrae are removed through a 3–4 cm incision using a microscope. This method aims to alleviate pain and other symptoms by reducing pressure on the nerve roots.
Anterior Cervical Microdiscectomy and Fusion (ACDF): ACDF is a microsurgical technique used to treat cervical disc herniations (neck herniations). Through a small incision in the front of the neck, the disc structure of the cervical spine is accessed, and the damaged disc is removed with the aid of a microscope to relieve pressure on the nerve. A small cage is placed in the resulting space to maintain spinal stability.
Minimally Invasive Spine Surgery (Endoscopic Surgery): In suitable patients, many spinal procedures that were previously performed using a microscope can now be performed using an endoscope. An endoscope and camera are inserted into the affected area through an incision less than 1 cm in length. The procedure is performed on the spine through this small opening. Postoperative pain from muscles and bones is reduced, and the recovery process is faster. Because the incision is smaller than 1 cm to the naked eye, it is commonly referred to by the public as “closed surgery.”
Laminectomy: A laminectomy is a procedure in which the bony structure called the lamina, located at the back of the vertebrae, is removed to widen the spinal canal. This method reduces pressure on the nerve roots in conditions such as spinal stenosis and provides relief to the patient. In select cases, the laminae on both sides can be removed via a single-sided approach using a microscope without performing spinal screw fixation (stabilization).
Spinal Stabilization: Spinal stabilization is the procedure of fusing two or more vertebrae using a system of screws and rods. This method is used to increase spinal stability and reduce pain. In patients with severe instability, bone grafts, cages, and special implants are used; bone grafts and metal implants are typically used during fusion.
Scoliosis Surgery: Scoliosis is defined as a lateral curvature of the spine exceeding 10 degrees. In severe cases, surgery is necessary. Corrective surgeries are performed on the spine using screws and rods.
Kyphosis Surgery: Kyphosis (hunchback) is a forward curvature of the spine caused by aging or rheumatic diseases such as ankylosing spondylitis. Surgery is required in severe cases. Kyphosis correction surgeries are performed using screw and rod systems, enabling the patient to stand straighter and look forward after surgery.
Vertebroplasty and Kyphoplasty: Vertebroplasty and kyphoplasty are minimally invasive procedures used to treat spinal fractures. In these procedures, a special cement is injected into the vertebra to stabilize the fracture and relieve pain. Kyphoplasty can also help restore the vertebral body’s height using an auxiliary device, such as a balloon, placed within the spine.
Spinal Cord Stimulation: Spinal cord stimulation involves the implantation of a device that sends electrical impulses to the spinal cord. It helps restore electrical conduction in the spinal cord for patients with spinal cord injuries caused by trauma or tumors. It provides a foundation for more successful progress in subsequent physical therapy. It is also used for chronic pain associated with spinal disorders or tumors.
Sacral Cord Stimulation: Sacral cord stimulation can be used in selected patients who are unable to control their bladder and bowel movements as a result of spinal cord injury. An electrode implanted in the sacrum is connected to a battery under the skin. The electrical impulses from the battery stimulate the muscles that control urination and bowel movements. Combined with pelvic floor exercises, it helps the patient regain control of their bladder and bowel movements.
The Spine Unit (Spine Surgery) adopts a multidisciplinary approach to the diagnosis and treatment of spinal disorders. Patients’ postoperative rehabilitation processes are closely monitored, with the goal of maximizing their quality of life.
How Are Spinal Disorders Diagnosed?
Diagnosing spinal disorders requires a detailed evaluation. The methods used in the diagnostic process include:
Patient History and Physical Examination: The diagnostic process begins by listening to the patient’s symptoms and conducting a physical examination. The doctor assesses the location and severity of the pain, as well as other symptoms.
Imaging Methods: Imaging methods such as X-rays, magnetic resonance imaging (MRI), and computed tomography (CT) are used in the diagnosis of spinal disorders. These methods provide a detailed view of the spine’s structure and any potential abnormalities.
Laboratory Tests: In some cases, blood tests may be performed to evaluate conditions such as infection or inflammation.
Biopsy: A biopsy involves taking a tissue sample for pathological examination in cases of suspected tumors or infections. This method is crucial for establishing a definitive diagnosis and may be necessary prior to spinal surgery in some cases.
What Are Non-Surgical Pain Management Approaches?
Spine surgeons are physicians specialized in the treatment of spinal disorders, and in many cases, they also play a significant role in non-surgical pain management and treatment. The primary pain management methods used by spine surgeons include:
Injection Therapies
Spine surgeons may administer various injection therapies to relieve pain. These treatments include:
- Epidural Steroid Injections: These reduce pain by decreasing swelling in the nerve roots.
- Facet Joint Injections: Used to reduce pain in the facet joints, which are the joints where two vertebrae meet.
- Sacroiliac Joint Injections: Relieve pain originating from the sacroiliac joints.
Nerve Blocks
Nerve blocks are procedures that temporarily deactivate the nerves that transmit pain. This method provides relief by blocking pain signals.
Radiofrequency Ablation
Radiofrequency ablation is a procedure in which nerves causing pain are destroyed using heat energy. This method provides long-term pain control.
When Should Emergency Spinal Surgery Be Performed?
Emergency surgery in spinal surgery is necessary when life-threatening conditions or situations that could lead to permanent damage arise. These emergency conditions include spinal cord compression, cauda equina syndrome, spinal fractures, spinal infections, and rapidly growing tumors.
It is critically important for patients experiencing weakness in the arms or legs, or urinary incontinence or inability to urinate, to seek immediate medical attention. A specialized spine surgeon can perform the necessary surgical intervention in emergency situations using the correct diagnosis and treatment methods.
