Spine is made up of many individual bones called vertebrae, joined together by muscles and ligaments. Flat, soft inter-vertebral discs separate and cushion each vertebra from the next.
Because the vertebrae are separate, the spine is flexible and can bend. Together the vertebrae, discs, muscles, and ligaments make up the vertebral column or spine.
Spine surgery is an invasive pain management procedure in which a specially trained doctor (the surgeon) uses instruments to make incisions to repair damaged spinal tissues.
Or in other words Spine surgery whether back or neck surgery, can be sum up as an advanced treatment option for pain and disability caused by an identifiable lesion in the patient's anatomy that has not adequately improved with non-surgical treatments. Although spinal arthritis tends to be chronic, the symptoms are rarely progressive and rarely require surgery on the painful spinal joints.
Fractures of the thoracic and lumbar spine are usually caused by high-energy trauma, such as:
Spinal fractures are not always caused by trauma. For example, people with osteoporosis, tumors, or other underlying conditions that weaken bone can fracture a vertebra during normal, daily activities.
There are different types of spinal fractures. Doctors classify fractures of the thoracic and lumbar spine based upon pattern of injury and whether there is a spinal cord injury. Classifying the fracture patterns can help to determine the proper treatment. The three major types of spine fracture patterns are flexion, extension, and rotation.
The primary symptom is moderate to severe back pain that is made worse by movement.
When the spinal cord is also involved, numbness, tingling, weakness, or bowel/bladder dysfunction may occur.
In the case of a high-energy trauma, the patient may have a brain injury and may have lost consciousness, or "blacked-out." There may also be other injuries — called distracting injuries — which cause pain that overwhelms the back pain. In these cases, it has to be assumed that the patient has a fracture of the spine, especially after a high-energy injury (motor vehicle crash).
At first evaluation, it may be difficult to assess the extent of injuries to patients with fractures of the thoracic and lumbar spine.
At the accident scene, EMS rescue workers will first check vital signs, including the patient's consciousness, ability to breathe, and heart rate. After these are stabilized, workers will assess obvious bleeding and limb-deforming injuries.
Before moving the patient, the EMS team must immobilize the patient in a cervical (neck) collar and backboard. The trauma team will perform a complete and thorough evaluation in the hospital emergency room.
An emergency room physician will conduct a thorough evaluation, beginning with a head-to-toe examination of the patient. He or she will inspect the head, chest, abdomen, pelvis, limbs, and spine.
The treatment plan for a fracture of the thoracic or lumbar spine will depend on:
Once the trauma team has stabilized all other life-threatening injuries, the doctor will evaluate the spinal fracture pattern and decide whether spine surgery is needed.
These fractures should be treated surgically with decompression of the spinal canal and stabilization of the fracture. Decompression involves removing the bone or other structures that are pressing on the spinal cord. This procedure is also called a laminectomy.
To perform the decompression, your surgeon may decide to access your spine with an incision either on your side or on your back. Each approach allows for safe removal of the structures compressing the spinal cord, while preventing further injury.
The treatment plan for extension injuries will depend on:
Rotation Fracture Pattern
The ultimate goal for surgery is to achieve adequate reduction (fitting the bones together), relieve pressure on the spinal cord and nerves, and allow for early movement.
Depending on the fracture pattern, your surgeon may decide to do the procedure through an anterior (front), lateral (side), or posterior (back) approach, or a combination of all three.
Many types of instruments are used in surgery, including metal screws, rods, and cages to stabilize the spine.
There are several complications associated with fractures of the thoracic and lumbar spine. One potentially fatal complication is blood clots in the legs, which may develop from immobility. These clots can travel to the lungs and cause death (pulmonary embolism). Pneumonia and pressure sores are also common complications of spinal fractures.
There are also specific surgical complications, including:
Complications can be reduced by early treatment, mechanical methods (lower leg compression stockings), and medication to protect against clots, as well as proper surgical technique and postoperative programs.
Regardless of whether the patient is treated with surgery, rehabilitation will be necessary after the injury has healed.
The goals of rehabilitation are to reduce pain, regain mobility, and return the patient to as close to preinjury state as possible. Both inpatient and outpatient physical therapy may be recommended to meet these goals.
Issues that may complicate these goals include inadequate reduction of the fracture, neurologic injury (paralysis), and progressive deformity.