Spinal instrumentation
Spinal instrumentation in nagpur refers to the use of different devices and implants towards the stabilization and support of the spine to give it additional stability. The ultimate goal of the use of spinal instrumentation is to:
1. Stabilize the spine.
2. Decompensate deformities (for example, scoliosis, spondylolisthesis)
Relieve pressure on nerves and spinal cord:
4. Promote bone growth between vertebrae
Spinal instrumentation is used in a various procedures, such as:
1. Spinal fusion
2. Scoliosis correction
3. Spondylolisthesis reduction
4. Spinal tumor resection
5. Spinal fracture stabilization
6. Degenerative disc disease treatment
What Is a Spinal instrumentation?
Instrumentation of the spine is the procedure where many devices and implants are used to stabilize and align the spine.
Spinal instrumentation devices:
1. Rods
2. Screws (pedicle screws, facet screws)
3. Plates
4. Cages (interbody fusion devices)
5. Hooks
6. Wires
7. Artificial discs
The procedure entails:
1. Incision and exposure of the spine
2. Inclusion of instrumentation devices.
3. Correction or stabilization of the deformity of the spine
4. Closing of the incision
The use of spinal instrumentation for treatment applies to the following diseases:
1. Spinal fractures
2. Scoliosis
3. Spondylolisthesis
4. Tumors in the spine
5. Degenerative disc disease
6. Spinal stenosis
Spinal instrumentation is aimed at stabilizing the spine and ensuring there is enough support for healing and alleviation of symptoms such as pain and paresthesia, and weakness.
Purposes of Spinal Instrumentation:
Spinal instrumentation is primarily used to:
- Provide Stability: In cases of instability due to fractures, degenerative disc disease, or vertebral deformities, spinal instrumentation helps maintain the proper alignment of the spine.
- Enhance Fusion: In spinal fusion procedures, instrumentation holds the vertebrae together while the bone graft heals and fuses the vertebrae into one solid structure.
- Correct Deformities: Conditions like scoliosis, kyphosis, or spondylolisthesis can cause abnormal curvatures of the spine. Instrumentation helps straighten and correct these deformities.
- Protect Nerves: By stabilizing the spine, instrumentation helps prevent further damage to spinal nerves or the spinal cord caused by vertebral movement or collapse.
Types of Spinal Instrumentation:
There are various devices used in spinal instrumentation, depending on the patient’s condition and the surgeon’s preference:
- Rods: Long, metal rods are attached to the spine using screws or hooks. These rods maintain spinal alignment and support the spine as it heals.
- Screws and Plates: Pedicle screws are inserted into the vertebrae and connected by plates or rods to keep the vertebrae stable. They are commonly used in spinal fusion.
- Cages: Interbody cages are placed between vertebrae where the disc was removed. These cages are filled with bone graft material and provide space for the vertebrae to fuse.
- Hooks: Sometimes used instead of screws, hooks attach to parts of the vertebrae, particularly in the upper (thoracic) spine.
- Wires and Cables: Less commonly used, wires and cables can be employed to hold the spine together, especially in complex or reconstructive surgeries.
Conditions Treated with Spinal Instrumentation:
- Spinal Fractures: To stabilize vertebrae fractured due to trauma, osteoporosis, or tumors.
- Spinal Deformities: Such as a scoliosis, kyphosis, and lordosis.
- Degenerative Disc Disease: When the disc wears down, leading to instability.
- Spondylolisthesis: A condition where one vertebra slips over another, causing pain or instability.
- Spinal Tumors: To stabilize the spine after removing tumor-affected vertebrae.
- Spinal Infections: Sometimes used after infection-related damage to the spine is treated.
Procedure:
Spinal instrumentation is usually performed as part of a larger surgery, such as spinal fusion. The general steps include:
- Anesthesia: The patient is a placed under general anesthesia.
- Exposure: The surgeon makes an incision to access the spine.
- Placement of Instrumentation: Based on the patient’s condition, the surgeon will place the necessary rods, screws, or cages into or around the vertebrae.
- Spinal Fusion (if needed): A bone graft is used to encourage the vertebrae to fuse. The instrumentation keeps the vertebrae in place while the fusion occurs.
- Closure: The incision is closed, or a patient is moved to a recovery.
Materials Used in Spinal Instrumentation:
- Titanium: The most commonly used material, titanium is strong, lightweight, and compatible with the body (biocompatible), meaning it is less likely to cause an allergic reaction.
- Stainless Steel: Still used in some cases, but not as common as titanium due to its heavier weight and lower compatibility.
- PEEK (Polyetheretherketone): A newer material sometimes used in cages. It is radiolucent, meaning it does not show up on X-rays, which can make it easier for doctors to monitor fusion.
Risks and Complications:
Like all surgeries, spinal instrumentation carries some risks, including:
- Infection: Though uncommon, infections can occur around the instrumentation.
- Hardware Failure: Over time, the screws, rods, or other devices could become loose or break, especially if fusion does not occur properly.
- Nerve Damage: Misplacement of hardware or excessive pressure on nerves can lead to nerve damage.
- Pain: Some patients may experience pain or discomfort from the hardware.
- Adjacent Segment Disease: Stress on vertebrae adjacent to the fusion can cause them to degenerate over time.
Recovery:
Recovery from spinal instrumentation surgery varies depending on the condition treated and the extent of the procedure. General recovery details include:
- Hospital Stay: Typically, patients stay in the hospital for the few days after surgery.
- Pain Management: Pain medication is provided, and patients may also receive physical therapy.
- Activity Restrictions: Patients are advised to avoid heavy lifting, twisting, and bending during the early recovery phase.
- Healing Time: Full recovery can take several months. Bone fusion usually takes 3 to 6 months, during which is the instrumentation provides support.
- Follow-Up: Regular follow-up visits with imaging (X-rays or CT scans) are necessary to monitor healing and ensure the instrumentation is stable.
What procedures Spinal instrumentation?
The procedures of spinal instrumentation include:1. Spinal Fusion: The vertebrae are joined together using instrumentation devices in this process.2. Posterior Spinal Fusion: A joining in the posterior approach.3. Anterior Spinal Fusion: A joining in an anterior approach.4. Lateral Spinal Fusion: A joining in a lateral approach.5. Minimally Invasive Spinal Fusion: It is almost a procedure where a fusion is performed using fewer incisions and certain specialized instruments.6. Transforaminal Lumbar Interbody Fusion (TLIF): This is intervertebral fusion for lower back conditions.
7. Posterior Lumbar Interbody Fusion (PLIF): Lower back interbody fusion.
8. Anterior Lumbar Interbody Fusion (ALIF): Lower back interbody fusion.
9. Cervical Spinal Fusion: Interbody fusion of the neck.
10. Scoliosis Correction: Instrumentation in correction of spinal deformity
11. Spondylolisthesis Reduction: Reduction of slippage of vertebrate with instrumentation devices
12. Spinal Tumor Resection: Instrumentation-assisted removal of spinal tumors.
13. Stabilisation of Spinal Fractures: Instrumentation-assisted stabilization of spinal fractures.
These procedures may require the use of several instrumentation devices including:
Pedicle screws
Rod
Plates
Cages
Hooks
Wires
Artificial discs
Again, procedure and instrumentation used depend on the case and the surgeon.
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