Many patients mistakenly believe that neurosurgery is limited to the brain, but spinal procedures are an important aspect of this field of medicine. The brain and the spinal cord come together to form the central nervous system, so spinal disease, disorder, or malfunction typically affects neurological function. The spinal cord allows the brain to communicate back and forth with the rest of the body, so damage to this network of nerves, tissues, and fibers can severely disrupt patients' lives and ability to function.
The spine is a delicate system that requires extreme care and precision to correct. Neuro-spinal surgeons go through many years of education and training to learn how to safely and accurately perform procedures.
In many cases, neurologists can help patients manage neuro-spinal conditions with physical therapy, medication, lifestyle modifications, or other non-surgical treatments. However, in certain circumstances, surgical intervention is an invaluable strategy, helping to restore patients' wellbeing or even saving their lives. The spine is a delicate system that requires extreme care and precision to correct. Neuro-spinal surgeons go through many years of education and training to learn how to safely and accurately perform procedures. Below, we describe the various types of neuro-spine surgery.
Neuro-spinal specialists can perform many types of surgeries to alleviate uncomfortable symptoms, correct misalignment, and repair spinal structures. Spine surgery may correct unhealthy abnormalities in the spinal cord, nerves, ligaments, vertebrae, and the discs between them. It can be performed in the cervical, thoracic, lumbar, and sacral portions of the spine and surrounding tissues.
Tiny, camera-controlled tools perform minimally invasive procedures.
During conventional spine surgery, doctors use thin blades and manual instruments to open the skin and modify the tissue and bone beneath it. Recently, some neurosurgeons have implemented endoscopic techniques, using tiny, camera-controlled tools to perform minimally invasive procedures. Doctors may also use laser tools to adjust the spine, although these methods are relatively controversial in the field and are still being developed.
Some of the most commonly performed spine surgeries for spinal cord injury include:
- Discectomy. The discs between vertebrae can become herniated, meaning that part of their center protrudes through their tough exterior, or is otherwise damaged. This can occur anywhere along the spine, causing pain and weakness. Herniated discs can also lead to other spinal disorders. During discectomy, a neurosurgeon excises a portion or the entirety of the damaged disc to alleviate these symptoms. Discectomy can be a standalone procedure, or it may be performed in conjunction with spinal fusion, laminectomy, or other surgeries.
- Disc Replacement. This procedure is the same as discectomy, except that the neurosurgeon inserts a prosthetic spinal disc after removing the natural tissue. Some patients tolerate disc replacement more easily than spinal fusion.
- Spinal fusion. Patients with scoliosis, kyphosis, fractures, herniated discs, or other spinal disorders may benefit from spinal fusion surgery. This technique usually involves removing the natural disc between vertebrae and then placing a bone graft between the affected vertebrae to adjoin them. Doctors may also use surgical instruments such as plates, wires, cables, or screws to create the framework for spinal fusion. After this surgery, the bones gradually integrate for six to nine months, completing the process. This surgery can stabilize the spine and reduce related nerve issues. Spinal fusion sometimes requires revisional surgery to fully correct.
- Laminectomy. Spinal stenosis, disc herniation, and other issues can cause nerve compression and shrink the spaces between spinal structures. To correct this condition, neurosurgeons can perform laminectomy, during which they remove a segment of the lamina, the top portion of the bone that encloses the spinal cord. This can alleviate pressure on nerves and tissues.
- Interlaminar implant. As part of a laminectomy, a neurosurgeon can also place an interlaminar implant, a U-shaped prostheses that decompresses the spine and provides more space for nerves and spinal cord tissue.
- Foraminotomy. The foramen is a hollow bone that protects the nerve roots along the spinal column. If this bone becomes damaged or too narrow, it can interfere with nerve function. In this instance, neurosurgeons can perform foraminotomy surgery, a procedure to adjust soft tissues and bones in the foramen. If neurosurgeons significantly alter the foramen or remove a large portion of it, they may term this surgery a foraminectomy instead.
- Kyphoplasty®. Using this modern surgical strategy, neurosurgeons use x-ray imaging to map the spine, and then use a needle and balloon to enlarge the space between malfunctioning vertebrae. Once there is adequate room for it, they inject special bone cement into the area to support the spine.
- Osteotomy. In cases of severe spinal misalignment or deformity, neurosurgeons may recommend osteotomy. During this procedure, they strategically fracture or break vertebrae or other spinal bones to improve posture and correct structural abnormalities. Ideally, the affected bones will adapt and heal in a way that benefits the spine.
Neurosurgeons provide brain surgery to patients who suffer from neurological conditions related to physical irregularities in their brain tissue and nearby regions. These abnormalities could stem from congenital defects, traumatic injuries, disease, or other conditions. Given the vital importance of the tissue involved and the risks of surgery, neurosurgeons typically only recommend brain surgery when these procedures are absolutely necessary. Brain surgeries may be performed traditionally, with thin blades and specialized instruments, or endoscopically, using tiny, camera-controlled tools to improve precision and diminish the risk of side effects. Depending on the severity of the disorder, brain surgery can be performed on a preventive or emergency basis.
The following brain disorders may merit surgery (if other treatment methods are not available or successful):
- Parkinson's disease
- Benign or malignant brain tumors
- Dura (damaged protective tissue in the brain)
- Blood vessel damage
- Aneurysm (enlarged arteries)
- Nerve disorders
- Degeneration as a result of traumatic injury
- Excessive bleeding or clotting
The specific actions performed during brain surgery depend on the segments of tissue affected by the trauma, disease, or disorder. However, most brain surgeries involve one or more of the following techniques:
- Craniotomy. During this procedure, a neurosurgeon incises and removes a small segment of the skull in order to access underlying tissue. Once he or she has completed treatment, the surgeon then reconnects the lifted portion of bone with the rest of the skull.
- Craniectomy. Using this technique, the neurosurgeon does not replace the area of the skull that he or she removed at the end of the procedure.
- Biopsy. This surgery involves making a tiny opening in the skull to remove and test a small portion of tissue. This is a diagnostic procedure.
- Shunt surgery. If the brain is not circulating fluids properly, a neurosurgeon may place a shunt, or small surgical device, to improve the flow of liquid within the brain.
- Tumor removal. This surgery involves removing as much of a brain tumor as possible, depending on the size and location of the growth. When neurosurgeons cannot excise the entirety of a tumor, they refer to this procedure as "debulking" or "partial removal."
- Ommaya reservoir placement. During this procedure, a neurosurgeon installs a tool called an Ommaya reservoir directly beneath the scalp. This container is connected to a thin tube that extends outside of the skull. After Ommaya reservoir placement, doctors can use this device to drain unhealthy fluids, test cerebrospinal fluids for disease, or provide chemotherapy for brain cancer.
- Neuroendoscopy. Neurosurgeons who use this technique make small holes in the skull, through which they insert endoscopes to perform a variety of procedures.
- Endonasal surgery. Using this minimally invasive technique, neurosurgeons can insert endoscopes into brain tissue through the sinuses, nose, or mouth. This allows them to avoid changing the structure of the skull, reducing the risk for complications and shortening recovery time.
Given the delicate nature of brain surgery, most doctors use information collected from MRI (Magnetic Resonance Imaging) or CT (Computed Tomography) scans to carefully plan and execute these procedures. They also typically work to disrupt as little brain tissue as possible for safe, effective results.
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Peripheral Nerve Surgery
Peripheral nerves are bundles of fiber, neuron, and tissue that send information to and from the spinal cord to the rest of the body. They allow people to feel sensation in their extremities, move their muscles, and generally control their bodies. As such, damage to the peripheral nerves can be debilitating, causing numbness, tingling, or even paralysis on one or both sides of the body. The peripheral nerves can become damaged as a result of certain disorders, such as Charcot-Marie-Tooth disease, or as a result of traumatic injury, compression, fractures, tumors, or other conditions. Fortunately, if surgical care is delivered expediently, these nerves can typically heal successfully (if gradually) to restore patients' mobility, nerve function, and overall wellbeing.
Damage to the peripheral nerves can be debilitating, causing numbness, tingling, or even paralysis on one or both sides of the body.
Since the peripheral nerves are widespread and relatively fragile, there are over a hundred different disorders that can affect them. As such, the surgical techniques used to mend them vary widely. However, some of the most common types of peripheral nerve surgery for nerve disorders include:
- Neurofibroma tumor removal. Patients who suffer from neurofibramatosis, a congenital condition, may develop benign growths in their peripheral nerves, especially in their ears. If these become especially large, damage surrounding tissues, or interfere with patients' overall health, neurosurgeons may perform surgery to remove them from the affected area.
- Schwannoma surgery. The myelin sheaths that enclose and safeguard the nerves are made of Schwann cells. When these mutate, they create Schwannomas, typically non-cancerous tumors around the peripheral cells. Schwannomas are often painful and can disrupt patients' vision, taste, coordination, and ability to eat. If these symptoms cannot be managed with medication or therapy, neurosurgeons may perform Schwannoma surgery to excise them from the affected areas.
- Sarcoma removal. Cancerous tumors that grow from the nerves' myelin sheaths are called sarcomas. If these cannot be treated with chemotherapy and radiation, they may require removal. Depending on the patient's unique symptoms and case, some sarcomas may also need surgery in addition to chemotherapy and radiation. This procedure can alleviate uncomfortable symptoms and help to stop the spread of cancer to other nerves or tissues.
- Decompression surgery. There are a number of reasons peripheral nerves may become pinched or compressed. Thyroid issues, autoimmune disorders, prior surgery, traumatic injury, chemotherapy, prolonged use of antiviral medications, and diabetes may increase the risk for this condition. Nerve compression can lead to loss of sensation, discomfort, muscular weakness, a prickling sensation, or limited mobility in the extremities. Specific, localized compression can also cause particular disorders, including carpal tunnel syndrome (which affects the hands), thoracic outlet syndrome (which radiates from the chest region to impact arm function), tarsal tunnel syndrome (which is commonly characterized by numbness in the feet), and other conditions. Typically, doctors recommend attempting to relieve nerve compression symptoms with steroid medications, anti-inflammatory drugs, and physical therapy before turning to surgery. If symptoms persist with these treatments, a neurosurgeon may perform decompression surgery. During this procedure, he or she will incise the ligaments, fascia (fibers), and blood vessels around the nerve, relieving the strain placed on the nerve. The nerve itself remains intact, but modifying the tissues around it can give it more room to function properly.
- Nerve repair procedures. The peripheral nerves can become torn, stretched, or otherwise damaged as a result of strain, injury, or other conditions. This can lead to discomfort, heightened sensitivity, postural issues, burning, tingling, prickling, numbness, or restricted mobility. If these symptoms cannot be effectively managed with medication or therapy, neurosurgeons may recommend nerve repair surgery. For simpler cases, doctors may be able to mend the nerve simply by suturing the damaged portions to reconnect them. However, if too much time has passed since the initial tear or the nerve does not respond well to suturing, a nerve graft may be necessary. During this procedure, a neurosurgeon takes a portion of healthy nerve tissue from a different area of the body and uses it to bind together the damaged portions of the affected nerve.
In all types of peripheral nerve surgery, neurosurgeons must weight the benefits of the procedure against the potential risks for complications in the affected nerve. These surgeries must be performed by experienced, qualified neurosurgeons and should be utilized only as needed.
Arthritis is a common, chronic condition that involves widespread joint swelling. This disorder can cause widespread discomfort, interfering with patients' mobility and quality of life. There are three forms of arthritis:
- Osteoarthritis involves progressive degeneration of joint cartilage. This is the most common form of this condition. It can cause stiffness, aching, sensitivity, limited mobility, inflammation, and muscular weakness.
- Rheumatoid arthritis is an autoimmune disorder in which the body attacks the synovial membranes, the protective coverings around the joints. It shares many of the same symptoms as osteoarthritis, and can also cause abnormal growths (called rheumatoid nodules), fatigue, anemia, fever, weight loss, and joint defects.
- Gout is a systemic condition in which the joints become inflamed due to an accumulation of uric acid crystals, which damage the tissue. Gout can create acute, painful episodes and lead to a persistent, dull ache. In many patients, gout symptoms are localized to the feet. Like rheumatoid arthritis, gout can lead to the development of nodules.
For most cases, surgery is not the preferred treatment method for arthritis. These disorders can most often be managed with physical therapy, lifestyle changes, orthopedic aids, steroid drugs, anti-inflammatory medications, or injections. However, more severe cases or arthritic complications may benefit from surgical intervention.
Neurosurgeons may perform the following procedures to treat arthritis:
- Osteotomy. Neurosurgeons typically recommend this procedure for patients who suffer from osteoarthritis. This surgery involves an incision into the affected bone, which takes pressure off of the damaged cartilage and improves its alignment.
- Joint replacement. Severe cases of arthritis may merit a full joint replacement. During these procedures, neurosurgeons remove the affected bones, tissues, and cartilage, replacing them with prostheses. Joint replacement is most often performed in the knees and hips.
- Bone or joint fusion. Also called arthrodesis, this procedure can take pressure off of arthritic joints and improve their function by integrating two bones or joints. During this procedure, neurosurgeons can use either bone grafts or metallic instruments to link two bones, stabilizing and strengthening the affected joints. Neurosurgeons most often perform fusion surgery for patients' wrists, fingers, thumbs, spines, and ankles.
- Tendon repair. Neurosurgeons can perform this surgery to reconnect tendons that have become stretched, ripped, or torn due to the pressure of arthritic joints. Doctors most often recommend this surgery for patients who suffer from rheumatoid arthritis.
- Nodule removal. Rheumatoid arthritis and gout patients who develop nodules may need these removed if they become painful, grow larger, or interfere with surrounding tissue.
- Decompression surgery. Arthritic joints may put undue pressure on related nerves, pinching them. For these patients, neurosurgeons can incise the surrounding tissue to alleviate pressure and expand patients' range of motion.
- Synovectomy. Since the immune system specifically targets the synovial membrane in rheumatoid arthritis, neurosurgeons may correct this condition by simply removing this diseased lining. Patients may need to undergo this procedure multiple times in the synovial membrane regenerates.
- Laminectomy. Arthritis in the spine can lead to the development of bone spurs, overgrown areas of tissue that can compress the nerves. If bone spurs cause damage, neurosurgeons can perform laminectomy surgery to remove them.
Even with the assistance of arthritis surgeries, many patients who suffer from these conditions still need to maintain behavioral changes, physical therapy, medication, and other treatments to enjoy an excellent quality of life and control their symptoms.
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