Anterior spinal surgery and stabilization of fractures or tumours.
The incision is made, under general anaesthetic, in the area appropriate to the level of interest. Therefore in the thoracic spine an anterior approach will be required through the chest and in the lumbar spine via the abdomen.
If the approach is being used through the chest then it is an operation which will take several hours to do. The patient is placed on their side with the left side uppermost. An approach via a rib is used and the chest opened. The lung is collapsed if necessary and the vertebra of interest often entirely removed. The space occupied by the vertebra is replaced via an expandable cage to take the anterior strain not completely absorbed by tumour or deformed vertebra following a fracture. Further supporting devices are often used anteriorly. If more support is required then pedicle screws and rods can be used posteriorly.
If the approach is via the abdomen due to the location of the pathology then again a lateral incision in the flank is used. The abdominal contents are dissected away from the spine and the vertebra removed. It is again replaced with an implant in the same way as in the thoracic spine. Again a posterior stabilisation may also be required.
These operations are complex and take several hours to do. If the surgery is carried out through the chest then a chest drain is often needed for 48 hours or so and the use of a high dependency bed is required. This is available in all of the hospitals that SpineWorks utilise. The recovery period is obviously longer than a simple operation and may take several months. Any neurological deficit, which required the operation, in the first place may take months to recover if indeed it does so.
The risks and complications of these procedures are related to the approach themselves. There is therefore the risk of haemorrhage as these are operations around major blood vessels. There is a risk of nerve injury although this is relatively small. There is a risk of chest complications if the operation is done via the chest and a risk of infections and clots in veins, covered by the use of anti biotics and TED stockings.
The idea of the surgery is to render the spine stable and therefore mobilisation is commenced as soon as practically possible. Patients who undergo this surgery are reviewed for twelve months after. X rays are taken during this time to ensure that the spine remains stable and that any bone graft inserted has fused. In tumour surgery, follow up radiotherapy or chemotherapy may be required and this will be co-ordinated with the relevant Consultant Oncologist.
If tumour or fracture surgery is required it is performed with a colleague who is a Consultant Vascular Surgeon. This is because a Vascular Surgeon is much more skilled at accessing the spine through the abdomen or the chest. The potential complications are therefore reduced. The surgery is also not as common for an Orthopaedic Surgeon.