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Complex spine Surgery include procedures which are more difficult than simple discectomy, laminectomy or 1 or 2-level spinal fusion. The conditions for which complex spine surgery may be a solution include degenerative scoliosis (curvature of the spine which comes on during the aging process), cases of malignant spine tumors, cases of severe spinal trauma, or cases in which there is significant misalignment of the spinal vertebrae, such as in Spondylolisthesis. Spondylolisthesis is found when one of the spine vertebra slips forward significantly on the one below it.
Anterior and posterior, cervical, thoracic, and lumbosacral instrumented spinal fusion operations are examples of complex spine surgery that our physicians perform on a regular basis.
Some spinal tumors, benign or malignant, require surgical intervention before or after non-operative treatments. Surgery is considered for tumors when pain is unresponsive to non-operative treatment, neurologic deficits progress, a specimen is needed, compression is present, vertebral destruction exists, and/or when spinal stabilization is necessary. The primary goals in surgery are to restore or preserve neurologic function, provide spinal stability, and reduce pain.
The spinal cord and its associated structures are rare sites of tumor occurrence. The most common tumors developing from tissues within the spinal cord are known as astrocytomas or ependymomas. Tumors may also develop from supporting tissues of the spinal cord and nerves, such as schwannomas, neurofibromas, or meningiomas. Many of these tumors are benign and may not spread beyond the spinal canal. Due to the compressive effect on the neural elements, however, these lesions can produce significant neurological deficit. Adjuvant therapy in the form of radiation or chemotherapy has little effect. Surgical resection is regarded as the treatment of choice.
Brain Tumor Resections can be performed via an Endoscopic procedure or via a traditional Craniotomy. The surgeon determines which procedure is appropriate for the tumor resection based on the type of tumor, location, size and patient evaluation. Once the approach is decided, the patient will also require a pre-surgery MRI or CT scan for precise surgical planning.
Minimally invasive Surgery (MIS) can be done as an alternative to traditional “open” surgery. The benefits of minimally invasive spine surgery include smaller incisions, less muscle or tissue damage, decreased blood loss and a shorter hospital stay following surgery. Minimally Invasive techniques in surgery can be used for both Brain surgeries and Spine surgeries. However, it should be noted that not every surgery and not every patient is an appropriate candidate for MIS. A full evaluation and examination must be done before a physician can determine if this type of surgical technique is recommended for a patient. The team of Central Florida Neurosurgery Institute is committed to offering patients innovative ways to treat their medical conditions and Minimally Invasive Surgery is just one of many options.
Laminectomy is surgery to remove the lamina. The lamina is the back part of the vertebra that covers the spinal canal. The procedure opens the area of your spinal canal to relieve pressure on the spinal cord or nerves at the specific level identified. The pressure can be caused by a variety of problems, including bony overgrowths within the spinal canal (known as spinal stenosis) or by a herniated disk. Laminectomy is most commonly performed on the vertebrae in the lumbar spine (lower back) and in the cervical spine (neck). Laminectomy is generally used only when more-conservative treatments — such as medication and physical therapy — have failed to relieve symptoms. Laminectomy also may be recommended if symptoms are severe or worsening dramatically.
Spinal fusion is surgery to permanently join (fuse) together two or more bones in the spine so there is no movement between them. These bones are called vertebrae. The surgeon may use a graft the bones together permanently. There are several different techniques to perform a fusion and they can include:
• Strips of bone graft material may be placed over the back part of the spine.
• Bone graft material may be placed between the vertebrae.
• Special cages may be placed between the vertebrae. These cages are packed with bone graft material.
The surgeon may get the graft from different places:
• From a bone bank, called allograft.
• A synthetic bone substitute can also be used.
• From another part of your body (usually around your pelvic bone). This is called an autograft. If this is indicated, your surgeon will make a small cut over your hip and remove some bone from the pelvis.
The vertebrae are often also fixed together with rods, screws, plates, or cages. These rods, screws, or cages are referred to as instrumentation and are used to keep the vertebrae from moving until the bone grafts fully heal.
Kyphoplasty or Vertebroplasty are both outpatient procedure used to treat painful compression fractures in the spine. In a compression fracture, all or part of a spine bone collapses. The difference between the two procedures is in vertebroplasty, physicians use image guidance to inject a cement mixture into the fractured bone through a hollow needle. In kyphohplasty, a balloon is first inserted into the fractured bone through the hollow needle to create a cavity or space. The cement is injected into the cavity once the balloon is removed. A neurosurgeon can evaluate your particular situation and determine which procedure is appropriate.
Endoscopic Procedures are minimally invasive procedures that use flexible tubes (endoscopes) that may or may not have a camera on the end of it. These flexible tubes which are advanced surgical tools allow physicians to make smaller incisions and obtain detailed video images of the brain. Small instruments that can cut, sample, or destroy abnormal tissue or tumors can also be passed through these tubes, allowing intricate surgery to be performed with little or no trauma.
A Craniotomy is the most commonly performed surgery for brain tumor removal. It also may be done to remove a blood clot (hematoma), to control hemorrhage from a weak, leaking blood vessel (cerebral aneurysm), to repair arteriovenous malformations (abnormal connections of blood vessels), to drain a brain abscess, to relieve pressure inside the skull, to perform a biopsy, or to inspect the brain.
A Craniectomy is similar to a craniotomy as both procedures involve removing a portion of the skull, the difference is that after a craniotomy the bone is replaced and after a craniectomy the bone is not immediately replaced.
A Cranioplasty is a surgical procedure to correct a deformity or defect of the skull and it is usually performed following a traumatic injury to the skull or after a previous brain surgery such as a craniotomy or craniectomy. In order to correct the defect the physician may have to use a prosthetic or other synthetic surgical material to complete the procedure.