What You Didn’t Know About Modern Advances in Spinal Surgery
Increasing life expectancy in our society, thanks to a healthier lifestyle and better living conditions, has brought new challenges to modern medicine, especially spinal surgery. One of these challenges is dealing with the consequences of degenerative spinal conditions or ‘wear-and-tear’ on the joints, muscles and ligaments of the spine, which is more prominent in the ageing population. All of us will experience neck pain and/or back pain at least once in our lifetime and these are amongst the commonest of symptoms prompting us to visit our family General Practitioner.
Although some degenerative spinal conditions cause trivial symptoms with minimum impact on your life, it can also become a disabling condition preventing you from performing your usual daily activities and, perhaps more importantly, being an active member of society. The first line of treatment in most spinal degenerative conditions is conservative management with pain-relieving medications, other natural therapies, physiotherapy and exercise. But unfortunately, in some cases conservative management will not be effective enough, providing a potential role for surgical intervention.
Spinal surgery carries some risks and has to be offered to only a selected group of patients when the benefits outweigh the risks. But, with recent advances in spinal surgery, more patients receive benefit from surgical intervention with less frequency of complications. You may have heard of keyhole surgery, robotic surgery and surgical navigation systems – all of which are being used in spinal surgery. Endoscopic spinal surgery which uses advanced surgical tools, an endoscope (which is a small tubular powerful magnifying system) inserted through a micro incision for visualization for the surgeon to perform the required procedure, enables surgeons to perform spinal procedures with minimally invasive techniques. Keyhole surgery is therefore now possible!
Robotic assisted surgery uses intraoperative imaging and navigation systems. Traditionally, surgeons perform complex spinal surgery by placing screws in the spinal bones either ‘free-hand’, using their judgement and feel, or with the assistance of multiple X-rays taken during the procedure. Intra-operative imaging, a CT scan during the operation, improves the accuracy of placement of spinal hardware (i.e. screws and plates). Navigation is the next step in that evolution.
Imagine a device similar to a ‘Sat- Nav’ that maps your spine, and which a surgeon can use. These ‘state-of-the-art’ intra-operative navigation systems now exist in everyday surgery, allowing surgeons to do very complicated procedures more safely, including the accurate placement of spinal prosthetics. If this helps to make incisions smaller with the muscles of the spine recuperating more rapidly, this reduces post-operative pain and length of hospital stay and means patients potentially recover much faster. Intraoperative imaging with a navigation system involves relatively low radiation for the patient, and effectively zero for the surgical team. Gone are the days of hours in lead aprons!
Outcome Measures have also been gradually increasing their role in spinal surgery too. Outcome Measures enable surgeons to quantify the quality of life improvement after any performed surgery. Different types of questionnaires, such as the Oswestry Disability Index, have been specifically developed and validated using statistical methods to quantify the effect of spinal procedures in improving patient quality of life, which is the ultimate goal for offering any spinal procedure.
Thankfully advanced techniques in performing spinal procedures, such as robotic surgery and navigation systems, endoscopes, and having outcome measure tools to identify the impact of spinal procedures in improving quality of life, have opened new horizons in the management of degenerative spinal conditions, which is one of the commonest problems our ageing population are faced with. Just imagine what the future holds!