Modern Back Surgery

There have recently been substantial medical innovations in the field of surgical management of spine related disorders and trauma. These innovations include imaging technology, new surgical procedures and advanced instrumentation.

An accurate diagnosis is always essential to treat any back condition or disorder. This highlights the need of advanced and accurate imaging techniques.

Imaging technology

Imaging techniques are a diagnostic tool that also aid in various therapeutic procedures. The commonly employed diagnostic techniques include X-rays, fluoroscopy, ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI)

X-Rays

They utilize electromagnetic radiations to generate 2-D images of the dense structures inside the body. For visualizing objects of a lower density, contrast media such as barium is employed. X-rays are widely employed for the diagnosis of spinal disorders and assist in monitoring treatment.

Fluoroscopy

It employs radiation along with video technology and contrast media to generate real time images of the internal organs. It helps in determining the size, shape and movement of the internal organs.

Ultrasound Imaging

It uses high-frequency sound waves to generate real time 3-D images of internal body organs. It has limited use in spinal surgery as compared to the other advance techniques such as CT and MRI scan. Recently, it is being used for guiding pedicle screws during scoliosis surgery.

Computed Tomography (CT)

It is one of the most advanced imaging techniques that generates precise 3-D images of the internal organs as well as the denser structures. It is the combination of computer system and X-ray imaging technique.

Magnetic resonance imaging (MRI)

It is one of the most advanced imaging techniques that uses magnetic and radio waves to generate precise 3-D images. It is widely used for evaluating various spinal conditions such as spinal stenosis, vertebral fractures, scoliosis, disc herniation, spinal tumors etc. The MRI scan uses a gadolinium-based intravenous contrast media to brighten the images of the CNS i.e. brain and spinal cord.

Surgical procedures

Some of the commonly employed surgical procedures for treating spine disorders include:

Discectomy

It refers to the surgical removal of a herniated disc that causes pain due to the compression of the surrounding spinal cord and/or spinal nerves. Some of the techniques employed for improving the stability of spinal fusion include:

• Advanced instrumentation (fixation devices, pedicles screws, titanium rods and plates)
• Bone grafts and bone substitutes
• Laser techniques for removing disc fragments
• Genetic engineering techniques for stimulating bone formation during spinal fusion

Microsurgery

It employs miniaturized instruments, high resolution microscopes and electrocautery devices for controlling hemorrhages for drying the operation area. Usually binocular microscopes are preferred over the monocular ones. In recent advances video cameras are used for assisting surgery through viewable ports.

Endoscopic surgery

It involves the use of small-sized video cameras and specially designed instruments which assist in various spinal surgeries and is performed through small incisions. The advantages of endoscopic surgery over open surgery are as follows:

• Requires smaller incisions
• Less post-operative pain
• Less damage to the surrounding tissues
• Minimal blood loss
• Quick recovery
• Reduced scars

Endoscopic surgery has been efficiently used in various neurosurgical procedures such as spinal arthritis, bone spurs, bulging discs, degenerative disc disease, facet syndrome, foraminal stenosis, herniated disc, sacroiliac pain, sciatica, spinal stenosis and synovial cysts.

Gamma Knife Stereotactic Radiosurgery (Non-invasive brain surgery)

It is a non-invasive form of brain surgery which is employed for controlling the growth of brain tumors without affecting the neurological functioning of the brain. The device employs 201 cobalt 60 gamma radiation emitters that are placed in a circular array of a specially designed helmet type stereotactic frame. The frame is attached to the head of the patient to be treated. The beams of the gamma radiations are focused with the help of a positioning system that prevents damage to the surrounding healthy tissues. The gamma radiations kill the tumor cells by damaging the intracellular DNA. The advantages of gamma knife stereotactic radiosurgery are as follows:

• Lack of incision minimizes the risks of hemorrhage, infection and adverse effects of anesthesia
• Less time consuming procedure; takes about 12-15 minutes
• No post-operative pain or inflammatory response
• Less expensive

Dr Gary Kraus has experience of more than 10 years and has performed over 2000 gamma knife surgeries.

Computer-guided spine and brain surgery

Dr. Kraus employs a computer system along with advanced imaging techniques and high-resolution surgical microscopes, for performing minimally invasive spine and brain surgeries. The advanced technology help in creating 3-D models of the spine or brain. This aids in navigation to the involved lesion for efficient treatment of various CNS disorders. It also reduces the risk of injury to the spinal cord or brain tissues and peripheral nerves.

Artificial disc replacement

Recently artificial discs made from biocompatible material, similar to the normal disc, in terms of disc geometry, survival and kinetic dynamics are used successfully. Artificial disc replacement is found to be superior and healthier than prosthetic implants.

Instrumentation

Various instruments such as screws, plates, rods, hooks, wires and interbody cages are being used in different surgical procedures, for better fusion. Dr Gary Kraus and other researchers are continuously working on improving biomechanics and developing smaller devices that can be employed in minimally invasive procedures. The traditional suture material for closing the incision is replaced by advanced techniques such as metal staples, skin adhesives and surgical glues.

Neurostimulation systems of pain management

Neurostimulation devices are being used for managing chronic spinal pain. Devices such as the transcutaneous electrical neurostimulators (TENS) have been efficiently used in managing various neural pathologies such as low back pain, osteoarthritis, chronic musculoskeletal pain and post operative pain.