We use standard surgical methods accepted by the surgical community in general and that studies have shown to be the most effective. This does not mean, however, that there are no opportunities for further development. We are, in fact, involved in researching ways to improve results attained with the existing techniques and instruments and ways by which new instruments could improve efficacy of these conventional methods.
Our work encompasses the entire spine, extending to the surgical treatment of:
- degenerative changes,
- accidental trauma, and
- changes due to inflammation.
Surgery in Cases of Degeneration
Herniated or slipped disc removal (discectomy) is the simplest and most common form of decompression surgery. The spine region most prone to disc injury requiring this type of surgery is the area containing the last two segments of the lumbar spine. The next most common region for disc herniation is the lower mid-cervical (neck) segment, though, in practice, surgery can usually be avoided here and is seldom necessary. Herniation of the thoracic segment requiring surgery is rarer still.
A similar surgical intervention, the recalibration, is used to re-establish the original dimensions of the spine segment in cases of bony spine compression.
If, at the start of surgery, the spine segment to be operated on is found to be unstable or is injured during the decompression phase, the segment must first be stabilized. The goal is to attain bony fusion of either two neighbouring vertebrae or two separate pieces belonging to another vertebra.
In some cases, bone alone (generally the patient's) can be implanted with no added metal fixation. Here, the patient is fitted with a temporary exterior fixation (corset) to be worn for a few months. Exceptions to this are certain cervical spine operations where the bone implant, in itself, can provide the needed stability until the bony fusion is completed. This usually takes about three months.
Fusion of the lumbar spine, on the other hand, takes significantly longer with most cases requiring internal fixation with metal implants. The results, however, are also better. The patient can resume weight bearing sooner and rehabilitation is better and faster.
In internal fixation, it is essential that the newest, well-tested and certified materials are used. Originally, rust proof steel was the metal of choice. Now titanium is the most commonly used material. The elasticity of titanium strongly resembles that of the bone, it is not as prone to loosening, does not cause chemical, biological or physical reactions within the body and is not corrosive. With the proper surgical techniques, the implants placed within the bone, or near it, should not cause the patient any discomfort.
Surgery Due to Accidental Trauma
We see relatively few trauma patients, since in this country accident victims are generally treated in trauma centers and in hospitals with trauma wards. We will, however, accept special cases where only the spine is injured.
The major force that had caused the spine injury destabilized the spine. In order to re-establish the stability, fixation (fusion) must be done, usually involving a larger segment of the spine. The most important purpose of this surgery is the re-establishing of the original structure of the spinal canal, to stop and possibly reverse nerve damage and to preclude paralysis. Time, as well as the surgical methods and techniques used, is critical in the fight against the chance of permanent damage.
Surgery Necessitated due to Inflammation
Though we see increasingly more cases of infection, it is still one tenth of the total number of spine tumors cases we see. Just as in tumors, progressive instability results which, in the majority of cases, requires intervention and fixation. The operation has a threefold objective: to eliminate the core of the infection, to stop pressure on the nerve and to re-establish spine stability. This is accomplished with internal fixation and debridement where the infected area is thoroughly cleansed by continued flushing for 5-7 days. This is followed by antibiotic treatment, sometimes continued for months, and in cases of TB, for years. The Patient must be kept under observation and checked regularly. Temporary external fixation is also often necessary.