Spinal Deformity Surgery

The Spine or backbone provides stability to the upper part of our body. It helps to hold the body upright. It consists of several irregularly shaped bones, called vertebrae appearing in a straight line. The spine has two gentle curves, when looked from the side and appears to be straight when viewed from the front. When these curves are exaggerated, pronounced problems can occur such as back pain, breathing difficulties and fatigue and the condition will be considered as deformity. Spine deformity can be defined as abnormality in the shape, curvature and flexibility of the spine.

The different types of spinal deformities include scoliosis, lordosis and Kyphosis. Scoliosis is a condition where the spine or back bone is curved sideways instead of appearing in a straight line. It curves like an “S” or “C”shape. Lordosis is a condition characterized by abnormal excessive curvature of the spine, sometimes called swayback. Kyphosis is a condition where an abnormal curvature of the spine occurs in the thoracic (chest) region resulting in round back appearance.

There are different surgical approaches to repair these deformities and the choice of the approach to the spine is based on the type of deformity, location of the curvature, ease of access to the area of the curve and the preference of the surgeon.

Anterior approach – In this procedure, the surgeon will approach the spinal column from the front of the spine rather than through the back. The incision is made on the patient’s side, over the chest wall or lower down along the abdomen, depending on the part of the spine that requires correction. The lung is deflated and a rib is removed in order to reach the spine. After the exposure of the spinal column, the disc material between the vertebrae involved in the curve is removed. Screws are placed at each vertebral level involved in the curve, and these screws are attached to a single or double rod at each level. After instrumentation a fusion is performed, the bony surface between the vertebral bodies is roughened and bone graft is placed. A combination of compression along the rod and rotation of the rod will correct the spine deformity. The incision is closed and dressed.

Posterior approach – It is the most traditional approach and the approach is made through the patient’s back while the patient lies on his or her stomach. The incision is made down the middle of the back. Hooks are attached to the back of the spine on the lamina, and screws are placed in the middle of the spine. After the placement of hooks and screws, a rod that is bent and contoured into a more normal alignment for the spine is attached and the correction is performed. After the final tightening, the incision is closed and dressed.

Anterior and posterior approach – This approach is used in cases where the curve is stiff and severe. The first approach to spinal column is made from the front. The incision is made on the patient’s side, over the chest wall or lower down along the abdomen. Disc material between the vertebrae is removed. This procedure requires removal of a rib, which is later used for bone grafting.

After the anterior procedure, the wound is closed and the patient is positioned for the posterior approach. The incision is made down the middle of the back. Hooks are attached to the back of the spine on the lamina, and screws are placed in the middle of the spine. After the placement of hooks and screws, a rod that is bent and contoured into a more normal alignment for the spine is attached and the correction is performed. After the final tightening, the incision is closed and dressed.

Video-assisted thoracoscopic surgery (VATS) –This is a minimally invasive technique performed using a small video camera. The patient lies on his or her side; four incisions of 1 inch are made on the side of the chest wall. A thoracoscope, a thin instrument with a tiny camera and light at its end, is inserted through one of the incisions. The thoracoscope transfers images of the inside of the chest onto a video monitor, guiding the surgeon to perform the procedure. Retractor, suction and other surgical instruments are inserted through other incisions. Steps involved in the anterior approach are performed which involves intervertebral disc removal, bone grafting and instrumentation. Lung is deflated to gain access to the spine. The incisions are closed with an absorbable suture and the deflated lung is re-inflated.

Robotic Spine Surgery

Robotic Assisted Spine Surgery is a minimally invasive spine surgery where the surgeon is assisted by a robotic system (Da Vinci surgical system) to perform the surgery. Robotic systems are becoming increasingly popular in the medical fraternity owing to the unique advantages including the precision, safety and many other advantages. The da Vinci® robotic surgical system is one of the popular and widely employed robotic systems in the specialty of medicine and is used to perform various surgical procedures.

Conventional spine surgery uses a large incision and patients may experience complications such as pain, damage to the surrounding organs and nerves and long recovery period. In contrast, the da Vinci® robotic system is the most effective and least invasive technique which ensures faster recovery with minimal pain and minimal risks as compared with conventional spine surgery. Robotic spine surgery is indicated in patients suffering from chronic, debilitating back pain or restricted range of motion caused by spinal deformities and degenerative conditions.

The da Vinci® surgical system consists of a surgeon’s console, a patient-side cart with four interactive robotic arms, a high-performance vision system (3D camera) and miniaturized EndoWrist surgical instruments.

Unlike the traditional surgery, this procedure is performed through small incisions. The surgeon sits on a console and controls the movement of the robotic arms holding the special surgical instruments. The movements of the surgeon’s hands are translated, by the robotic system, into precise movements of the miniaturized instrument that are held by the robotic arms. Moreover, this approach also provides the surgeon with 3D, magnified view of the operating area. The enhanced vision and superior control of the micro-instruments improves the precision of the surgery.

Being a minimally invasive approach, robot spine surgery offers the following benefits:

• Smaller incisions leading to reduced scarring and minimal blood loss
• Less post-operative pain
• Shorter hospital stay and recovery period
• Quicker return to daily normal activities
• Lower incidence of complications

The da Vinci® Robot System is considered safe and effective, but may not be appropriate for everyone. Always discuss with your doctor about all treatment options suitable for you, as well as the benefits and risks.

Other Complex Spine Surgery List