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YOU are here : Home > Spinecare Topics > Options for Spine Treatments > Benefits and Risks of Back Surgery
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Options for Spine Treatments
Benefits and Risks of Back Surgery
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Benefits and Risks of Back Surgery
Hardware Induced Nerve Impingement
Surgical placement of hardware can lead to physical compression of a spinal nerve. The most common instrumental cause for this complication is the pedicle screw. Pedicle screws are relatively common fixating devices used in the low back (lumbar spine). The pedicle screw is placed through an elongated bony extension of the vertebrae called the pedicle. The pedicles of adjacent vertebrae border the openings along the side of the spine (neuroforamen) where the spinal nerves exit the spine. A pedicle screw can penetrate the bone during placement and subsequently enter the opening where the spinal nerve lies. A poorly positioned pedicle screw can lead to direct or indirect compression of a spinal nerve. Slippage or breakage of an implant or instrumentation can lead to migration of fractured material into the central spinal canal or the neuroforamen and result in neurological compromise.
Spinal Instability
Most spinal surgical procedures require the removal of some bone to decompress the spinal cord, decompress a spinal nerve or to access other tissue is to be treated or removed. The more bone and supportive tissue that is to removed from a spinal segment, the greater the risk of creating a mechanically unstable (hypermobile) segment. For example, the removal of tissue during a wide decompressive laminectomy without fusion may create an unstable spinal segment. Spinal instability occurs when the bones of the spine (vertebrae) move too much relative to one another. If a vertebrae moves too much relative to the vertebrae above or below the excessive motion can result in injury to the spinal cord or nerve root. The presence of post-operative spinal instability often requires a re-operation with fusion.
Segmental Malposition (Positional Syndrome)
Surgical fusion can be performed at one or more levels of the spine. It is important for the surgeon to perform the fusion with the vertebrae in correct positions relative to one another. If a vertebra is surgically fused in a position of excessive flexion or extension relative to other segments it will contribute to additional strain on neighboring segments as well as more distant regions of the spine. A fused abnormal relationship can lead to symptoms including pain. The spine surgeon must always take into account postural curves and normal biomechanics when planning a fusion procedure. If two or more vertebrae are fused in a disrelationship to one another, it may result in a loss of the natural curve of the spine leading to multilevel spinal dysfunction.
Surgical placement of hardware can lead to physical compression of a spinal nerve. The most common instrumental cause for this complication is the pedicle screw. Pedicle screws are relatively common fixating devices used in the low back (lumbar spine). The pedicle screw is placed through an elongated bony extension of the vertebrae called the pedicle. The pedicles of adjacent vertebrae border the openings along the side of the spine (neuroforamen) where the spinal nerves exit the spine. A pedicle screw can penetrate the bone during placement and subsequently enter the opening where the spinal nerve lies. A poorly positioned pedicle screw can lead to direct or indirect compression of a spinal nerve. Slippage or breakage of an implant or instrumentation can lead to migration of fractured material into the central spinal canal or the neuroforamen and result in neurological compromise.
Spinal Instability
Most spinal surgical procedures require the removal of some bone to decompress the spinal cord, decompress a spinal nerve or to access other tissue is to be treated or removed. The more bone and supportive tissue that is to removed from a spinal segment, the greater the risk of creating a mechanically unstable (hypermobile) segment. For example, the removal of tissue during a wide decompressive laminectomy without fusion may create an unstable spinal segment. Spinal instability occurs when the bones of the spine (vertebrae) move too much relative to one another. If a vertebrae moves too much relative to the vertebrae above or below the excessive motion can result in injury to the spinal cord or nerve root. The presence of post-operative spinal instability often requires a re-operation with fusion.
Segmental Malposition (Positional Syndrome)
Surgical fusion can be performed at one or more levels of the spine. It is important for the surgeon to perform the fusion with the vertebrae in correct positions relative to one another. If a vertebra is surgically fused in a position of excessive flexion or extension relative to other segments it will contribute to additional strain on neighboring segments as well as more distant regions of the spine. A fused abnormal relationship can lead to symptoms including pain. The spine surgeon must always take into account postural curves and normal biomechanics when planning a fusion procedure. If two or more vertebrae are fused in a disrelationship to one another, it may result in a loss of the natural curve of the spine leading to multilevel spinal dysfunction.
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