Victims of auto accidents and especially those involving 18 wheeler trucks are often faced with undergoing one of several spinal surgeries. The surgeries most commonly seen in these type of injuries include cervical, thoracic and lumbar laminectomies, discectomies, foraminotomies and fusions. Essentially, the goal of the vast majority of these surgeries is to relieve or stabilize pressure on affected nerves.
To understand what an injured victim may have to undergo, it may be easier to first understand the simple basics of the spinal cord and nerve roots. Envision the spinal cord as a highway that runs its entire course within a tunnel. The tunnel is the spinal canal formed by the rings within the bones of the spine or vertebrae that are stacked one on top of the other from the skull all the way down to the pelvis. The nerve roots are the exits from the spinal cord highway that need to be able to emerge from the tunnel of the spinal canal. These nerve roots exit through foramen, or channels, on both right and left sides of where every two vertebrae come together. A surgeon’s primary goal is to maintain the flow of traffic through this highway and exits to make sure that the spinal cord and nerve roots are not pinched or compressed.
The four most common types of spinal surgery are:
- Laminectomy – Laminae are the flat bone shields that form the back of the spinal canal. Their normal purpose is to protect the spinal cord from being damaged from direct impact from behind. If the disc protrudes beyond its normal location back into the spinal canal, the spinal cord can become compressed between the protruding disc material and the laminae. Removal of the laminae, or laminectomy, can be performed to decompress the spinal canal and give the spinal cord more room to move.
- Discectomy – This is the removal of all or part of the damaged intervertebral disc which is bulging or herniated into the spinal canal. This can be done from the front or from behind.
- Foraminotomy – This procedure is an enlargement of the neural foramen, the channel through which the nerve roots exit the spinal canal. This passageway may be narrowed due to herniated disc material or by degenerative arthritis that results in overgrowth of bone. If the foramen becomes narrowed it can put pressure on the exiting nerve root causing severe pain and neurological problems. To relieve this condition, the surgeon must scrape the foramen out to remove the offending disc or bone material.
- Fusion – The goal of a fusion procedure is to use the power of the body’s healing ability to actually get bone of two fused vertebrae to grow together over time to create a strong connection. If the damage to a disc requires removal or if the interspace between two or more vertebrae is unstable, a fusion can be performed to make a permanent connection between two or more vertebrae. A variety of metal plates, screws and rods can be used to temporarily stabilize the fusion site while the bone growth takes place.
Several other less common surgical procedures include Intradiscal electrothermal (IDET) therapy which is the insertion of a wire into a damaged disc that is then heated to cause the disc material to contract and relieve nerve compression. Somewhat rarer is total disc replacement which placing a mechanical device into the disc space to restore stability without the loss of flexibility caused by traditional fusion. Recovery times vary for all of these procedures. Which procedure is best for each patient depends on his or her particular spinal injury and should only be determined by a qualified orthopedic or neurosurgeon after a complete examination and appropriate diagnostic testing.