The spinal cord is covered by three layers of tissue called meninges, the outermost being the dura mater. Although it is a rare complication, the dura may get injured or tear during spinal surgery resulting in the leakage of cerebrospinal fluid (CSF), which normally surrounds the brain and spinal cord. This can cause severe headaches and nausea. Spinal cord injury can occur as a result of trauma, or from arthritis, bleeding, cancer, infection and inflammation. The effects of a spinal cord injury can range from transient deficits to more serious complications such as paralysis or bladder and bowel dysfunction.
During spine surgery, injury may occur due to instruments used to decompress nerves, misplaced implants or grafts, manipulation and ischemia (compromised blood supply). The risk of having a spinal cord injury or a dural tear during spine surgery increases with age as your surgeon needs to cut through toughened spinal ligaments, and in the process, damage the dura. It may also occur in those with previous spine surgery or preexisting spinal cord compression. Surgery to the back of the spine has a higher risk of spinal cord injury or dural tears since it requires cutting through spinal ligaments, which may injure the dura or cord. Special precautions are taken before, during and after surgery to prevent a dural tear or spinal cord injury.
Dural tears are repaired using microsurgical techniques – using a microscope and a fine needle. Small dural tears are sutured or stapled close, while larger ones are reconstructed with a patch or graft. Fat or fibrin glue may be used as a sealant to reinforce the repair. Your surgeon will ensure that the repair is water tight and that the CSF does not leak. Following repair, complete rest is recommended. Fluid pressure on the repair site is minimized by maintaining a sitting or lying position depending on the site of the injury for a period of time.
Spinal cord injury due to trauma requires immediate medical attention to minimize the spread of damage. Your head, neck and back are stabilized to prevent additional injury. Treatment usually involves medication or surgery followed by physical therapy. Surgery may be performed to remove bone fragments, foreign bodies, implants or grafts compressing the spinal cord. Spine stabilization procedures may also be necessary.
Posterior 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 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.
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.
