The spinal cord provides communication between the brain and other organs with the help of nerves and is located in a thick membrane, just like the brain.
The spinal cord provides communication between the brain and other organs with the help of nerves and is located in a thick membrane, just like the brain. It extends from the skull to the waist within the bone called “vertebra”.
What is spine surgery?
The spinal cord provides communication between the brain and other organs with the help of nerves and is located in a thick membrane, just like the brain. It extends from the skull to the waist within the bone called “vertebra”. While the signals coming from the brain are transmitted to the arms and legs or other organs, data from different organs are also transmitted to the brain in this way. Due to these functions, patients may become paralyzed in case of any compression on the spinal cord. “Microsurgery” method is the most ideal operation technique in the treatment of these diseases. With the microsurgery technique, complex (more severe and difficult) spine surgeries can be performed successfully in the hybrid operating room.
Which diseases are treated with spine surgery? What are spine diseases?
We can divide spine diseases into 4 groups.
Congenital spine diseases (such as spina bifida, prolapsed cerebellum, tense spinal cord, scoliosis)
Degenerative (hernia, stenosis, scoliosis, spinal misalignment)
Those due to trauma (Fracture, spinal cord injuries)
Spine and spinal cord tumors
We see spinal degeneration diseases most frequently. A hernia occurs when the cartilage tissue called “disc” located between the vertebrae compresses the nerves going to various parts of our body due to the pressure of the vertebrae. Sometimes a sudden strain, lifting something heavy, a reverse movement, or even coughing or sneezing can cause a hernia. But the most important cause of hernia is age and repetitive minor trauma. It causes canal stenosis in later ages. Microsurgery is the most preferred treatment for advanced diseases that do not benefit from physical therapy and pain treatment.
Spinal cord tumors are tumors that occur in the bones, nerves or other soft tissues that make up the spine and spinal cord. It can occur in two ways: primary (primary) and metastatic (spread of another cancer). While primary tumors occur due to the actual cells that form the structure of the spine and spinal cord, metastatic tumors are a class of tumors that form in the spinal cord when a tumor that has previously formed in different parts of the body cannot be controlled and spreads to the spine. Metastatic tumors are quite common in men between the ages of 45-65. Early diagnosis has a very important place in spinal cord tumor treatments, as in other diseases.
What methods are used in spine surgery?
Today, “Microsurgery” is the best method. Screwing (platinum insertion) techniques, which we call stabilization, and bone cement applications can be done by open or closed method. Endoscopic techniques can be used in suitable patients.
What are the innovations in spine surgery?
Hybrid operating rooms (special operating rooms using advanced technological devices) have become popular today. By definition, “Hybrid operating room” is used for new concept operating room rooms where advanced medical imaging systems and medical devices can be used simultaneously. These operating rooms have systems such as advanced tomography-MRI devices, new generation microscopes and neuronavigation.
With the development of technology, the image quality of the microscopes and endoscopes (camera systems) used has increased. Thanks to the special new generation microscope, successful results are obtained with operations performed under hundreds or thousands of times magnification. Removing all tumors (increasing the amount of resection) is the most important factor affecting the prognosis and survival of patients. The biggest challenge in tumor surgery is that tumor tissue is rarely separated from normal tissue. Achieving this with a standard normal surgical microscope can sometimes be problematic. However, with new generation microscopes and using special light filters, tumor tissue stained with fluorescence, for example, can be easily distinguished from normal nerve tissue. Therefore, thanks to the special operating microscope combined with neuronavigation, maximum removal (resection) of the tumor is achieved with a smaller incision and with the least error. It is a system available only in certain hospitals in Turkey. Apart from tumor surgeries, in vascular diseases surgeries, the veins can be shown by adjusting the filter of the microscope thanks to the special substance given to the patient intravenously during the surgery. This increases the chance of surgical treatment of spinal cord vascular disorders more safely.
Neuromonitoring is a system that provides continuous monitoring of the brain, spinal cord, nerve roots and reflex pathways on the monitor by giving electrical stimulation through electrodes placed on the patient’s scalp and muscles during surgery, in order to minimize the damage (risk of paralysis) that may develop in the nerves during surgery, especially in tumor surgery and stabilization surgeries. . The surgeon is warned if there is a change in the values monitored by the neurologist throughout the surgery. In this way, the patient is prevented from developing irreversible damage (such as paralysis) and a decrease in the quality of life is prevented.
New generation neuronavigation is a “wayfinding or guidance” system. It calculates the coordinates with a system similar to GPS technology for a target to be visited in brain or spinal cord surgery and allows the surgeon to see 3-dimensional scanned images. With “neuronavigation”, a high-level design of computer technology, the targeted lesion in neurosurgery is approached with a high degree of accuracy (with a precision of less than 1 mm) and the damage that may occur to healthy tissue during the surgery is minimized. In this method, a tomography is taken during the surgery and transferred to the navigation device. Thus, various risk areas in the patient’s spine can be seen with real-time navigation during the surgery and planning is made accordingly. With the neuronavigation system, surgical site coordinates are calculated and the target is reached with minimal deviation. Thus, surgical success increases and the risks of death and injury are minimized.
With the screw, cage and prosthesis technologies used, patients live more comfortable lives after surgery.
Bone cutters and ultrasonic devices used during the removal of bone tumors and spinal tumors have also made these surgeries easier.
Which diseases that were once incurable can now be treated thanks to new developing technologies?
Treatment with “Microsurgery” to be performed in the hybrid operating room increases the surgical success of these patients. Today, with this technique, surgeries can be performed successfully on patients who could not undergo surgery in the past or who had very severe complications (such as paralysis) after surgery.
The risk of complications is especially high in large tumors or recurrent tumors that have been operated on several times. For this reason, surgeries could not be performed on these patients in the past or severe complications (paralysis resulting in disability) occurred. With the newly developed technology, satisfactory results can be obtained, especially in tumor surgery.
Advanced spinal irradiation techniques also increase this success. With the technique we call separation surgery, the spinal cord is separated from the tumor and pinpoint irradiation can be applied to the rest of the tumor with Cyberknife technology (Radiosurgery). This helps us to achieve local control of the malignant aggressive tumor.
What advantages do new technologies have for surgeons and patients? The patient’s quality of life, length of hospital stay, recovery time, life expectancy, etc. How is it affected?
The development of minimally invasive surgery techniques in our country and around the world has been simultaneous with the development of hybrid operating rooms. Therefore, the most difficult, problematic and complex surgeries can be performed more safely. In summary, the advantages of new technologies are:
It provides critical information to the surgeon at every stage, and the risk of repeating the surgery is reduced.
By moving perfectly on the sensitive anatomy, it allows us to have safer surgery and stay away from critical structures without disturbing the healthy anatomy of the patient.
Patients receive less radiation during surgery.
With a smaller surgical incision, surgery time is shortened. Bleeding during surgery is reduced and allows the patient to recover quickly.
This system minimizes the major risks of complex, difficult surgeries. It increases the success of stabilization surgeries performed with screws.
It reduces the risk of infection.
All of these bring advantages for both the patient and the physician, such as less surgical trauma, smaller incisions, shorter operations, less blood loss, fewer complications, less hospitalization, and less cost.