How is spinal instability treated?

In consultation with the patient, the neurologist will always seek to treat the patient’s symptoms in a non-surgical manner for as long as possible. If, in the course of time, it turns out that regular therapy is no longer effective, the neurologist will refer you to a neurosurgeon to discuss surgery. Surgery must always be considered a final treatment option.

Spondylodesis

Spondylodesis is a technique designed to join vertebrae. The following section specifically discusses joining the vertebrae of the lumbar spine. This is the lowest part of the spine, which is most prone to degeneration. Spondylodesis is a technique which has been employed for years, but which has become much more popular lately due to the recent availability of modern materials and technologies which make the procedure safer and more effective. On the down side, some doctors may be a little too keen to prescribe this operation. The decision to undergo this type of surgery should not be made lightly; it should be well informed and well considered.

Robot used to fuse vertebrae
Robot used to fuse vertebrae

There are several approaches to joining vertebrae, and several technologies that can be employed. For instance, the vertebrae can be accessed from nearly all sides: from the back, from the side and from the front. Each approach has its pros and cons. The surgeon will decide on an approach on the basis of the patient’s symptoms and the cause of these symptoms.

From the back (PLIF/TLIF))

At Bergman Clinics' Back and Neck Centre, spondylodesis is performed in a minimally invasive manner, which is to say through tiny incisions, thus causing the back muscle to remain largely in place. First one or more compressed sciatic nerves will be released through a four-centimetre incision in the middle of the back (PLIF) or a little to the side of the back (TLIF), by removing excess bone tissue, connective tissue and the protrusion of the intervertebral disc. Then the remainder of the intervertebral disc will be removed, to the extent that such is possible. Next the vertebrae will be joined. A little cage will then be placed in the disc space, after which the disc space will be filled with chips of the patient’s own bone, obtained from the excess bone tissue removed during the first part of the operation. This will help the vertebrae fuse properly. The direction of the screws that are to be implanted will be determined by a mini-robot called a Renaissance robot, using a thin metal rod. This will help the surgeon place the screws even more precisely, which will minimise the risk of additional nerve damage. Once the steel rods have been installed, hollow screws can be placed over these rods and screwed into the vertebrae, after which the connecting rods will keep the two screws on each side together.

In order to implant the screws and rods, we will use the Sextant system, which will enable us to insert both the screws and the rods through small incisions in the patient’s skin. This tends to be more effective than open surgery in terms of the amount of damage sustained by the muscles. The system is named after a navigation tool once used by seafarers, which it somewhat resembles.


Sextant instruction video

From the front (ALIF)

Patients who suffer degenerative disc disease are generally operated on from the front. After all, the sciatic nerves that leave from the spinal canal at the back of the spine are not being mechanically compressed, so there is no reason to join the vertebrae from the back.

The ALIF procedure is performed by gaining access to the patient’s abdominal cavity. The procedure involves removing an intervertebral disc from the front of the spine, after which a small fusion cage filled with cement will be placed in the now-empty space and fixed with four additional pedicle screws, so that there will be no more mobility between the vertebrae. In this way the vertebrae will be kept apart, and they will slowly fuse.

Synfix (DePuy Synthes)
Synfix (DePuy Synthes)

Minimally invasive techniques

There are many different minimally invasive techniques and methods, and there is no best method. The choice as to which method to use depends on the surgeon’s preferences and the patient’s situation. However, I do take the following things into account:

  1. 'If I can achieve the same result with a small incision, why would I make a large incision?'
  2. '2. I’ll make my incision as small as possible, and as large as necessary'.

So what happens when I undergo surgery?

Click the button below for some general information on operations performed by Dr Schröder.

Read more about spinal instability operations

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