Surgery might be necessary if the curvature is severe, or if there are serious neurological impairments. There are several procedures used to correct abnormal kyphotic curvature. The proper procedure will depend on the root cause of the curvature. The most commonly used correction is spinal fusion.
Fusion and Spinal Instrumentation:
This kind of spine stabilization surgery has been common for many years. It can be done alone or at the same time as a decompression surgery. In spine stabilization, the surgeon creates an environment where the bones in your spine will fuse together over time (usually over several months or longer). The surgeon uses a bone graft (usually using bone from your own body) or a biological substance (which will stimulate bone growth). Your surgeon may use spinal instrumentation—wires, cables, screws, rods, and plates—to increase stability and help fuse the bones. The fusion will stop movement between the vertebrae, providing long-term stability.
Spinal Fusion and Instrumentation is undertaken when simple decompression of the nerves is inadequate due to the presence of spinal instability (abnormal motion). A fusion procedure links adjacent spinal vertebrae by promoting bone growth between them. Doing so eliminates the pain associated with abnormal motion between the vertebrae and prevents further injury to the nerves caused by compression and traction on the nerves produced by the abnormal motion.
Kyphoplasty is a new, minimally invasive procedure for the treatment of compression fractures of the spine, usually due to osteoporosis. A compression fracture occurs when vertebrae (back bones), weakened by osteoporosis, collapse and become wedge shaped instead of rectangular. A person with multiple compression fracures might appear hunched, with a rounded back.Kyphoplasty gives surgeons a way to fix the broken bone without the problems associated with open surgery. Unlike open surgery, which involves an incision and the use of larger instruments, kyphoplasty is a minimally invasive procedure. It requires a small opening in the skin and small instruments. This lessens the chance of bleeding, infection, and injury to muscles and soft tissues. The goal of kyphoplasty is to return the fractured vertebra as close as possible to its normal height. This is done by inflating a balloon inside the fractured bone to restore the vertebral body to its normal size. Special cement is then injected into the bone, fixing it in place. The cement strengthens the broken vertebra and stiffens it in its original height and position. This reduces pain and spine deformity (kyphosis), enabling patients to get back to normal activities.
Pre Operating Procedure :
The decision to proceed with kyphoplasty must be made jointly by you and your surgeon. You should understand as much about the procedure as possible. If you have concerns or questions, talk to your surgeon. Kyphoplasty is normally done on an outpatient basis, meaning patients go home the same day as the surgery. You shouldn't eat or drink anything after midnight the night before.
The Operation :
The patient lies on his or her stomach. To begin, the surgeon cleans the skin on the back with an antiseptic. Then the skin over the problem area is numbed using an anesthetic. Patients may also receive general anesthesia to put them to sleep during the procedure. Two small openings are made in the skin on each side of the spinal column. Long needles are inserted through the openings. The needles are passed completely through the back of the spinal column into the fractured vertebral body. These needles serve as guides while the surgeon drills two holes into the vertebral body.The surgeon uses a fluoroscope to make sure the needles and drill holes are placed in the right spot. A fluoroscope is a special X-ray television that allows the surgeon to see your spine on a screen. The device works like a video, though the images are in the form of an X-ray. Metal objects show up clearly on X-rays. The needle is easy for the surgeon to see on the fluoroscope screen. This helps the surgeon know the needle goes into the correct spot. A hollow tube with a deflated balloon on the end is then slid through each drill hole. The balloons are inflated with air.
The balloon is then deflated and gently removed. Special instruments are used to fill the cavity with a soft cement-like material which quickly hardens to stabilize the vertebrae. This restores the height of the vertebral body and corrects the kyphosis deformity.
Spinal stenosis is a narrowing of the spinal canal, which places pressure on the spinal cord. If the stenosis is located on the lower part of the spinal cord it is called lumbar spinal stenosis. Stenosis in the upper part of the spinal cord is called cervical spinal stenosis. While spinal stenosis can be found in any part of the spine, the lumbar and cervical areas are the most commonly affected.
Surgical Treatment:
In many cases, non-surgical treatments do not treat the conditions that cause spinal stenosis, however they might temporarily relieve pain. Severe cases of stenosis often require surgery. The goal of the surgery is to relieve pressure on the spinal cord or spinal nerve by widening the spinal canal. This is done by removing, trimming, or realigning involved parts that are contributing to the pressure.The most common surgery in the lumbar spine is called Decompressive laminectomy in which the laminae (roof) of the vertebrae are removed to create more space for the nerves. A surgeon may perform a laminectomy with or without fusing vertebrae or removing part of a disc. Various devices (like screws or rods) may be used to enhance fusion and support unstable areas of the spine. Other types of surgery to treat stenosis include the following:
Laminotomy :
when only a small portion of the lamina is removed to relieve pressure on the nerve roots. After a retractor is used to pull aside fat and muscle, the lamina is exposed. Part of it is cut away to uncover the ligamentum flavum - a ligament that supports the spinal columnEntering the Spinal Canal. Next an opening is cut in the ligamentum flavum through which the spinal canal is reached. The compressed nerve is now seen, as is the cauda equina (bundle of nerve fibers) to which it is attached. The cause of compression may now also be identified - a bulging, ruptured or herniated disc, or perhaps a bone spur.Removal of the Herniated DiscThe compressed nerve is gently retracted to one side, and the herniated disc is removed. As much of the disc is taken out as is necessary to take pressure off the nerve. Some surgeons will remove all "safely "available" disc material. After the cause of compression is removed, the nerve can begin to heal. The space left after removal of the disc should gradually fill with connective tissue .
Foraminotomy :
When the foramin (the area where the nerve roots exit the spinal canal) is removed to increase space over a nerve canal. This surgery can be done alone or along with a laminotomy
Medial Facetectomy :
When part of the facet (a bony structure in the spinal canal) is removed to increase the spaceSagittal section throught the human lumbar vertebral spine. Facet joints are shown . The ligaments shown are intertransverse ligament (ITL), supraspinous ligament (SSL), interspinous ligament (ISL), ligamentum flavum (LF), anterior longitudinal ligament (ALL), posterior longitudinal ligament (PLL) and capsular ligament (CL).
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