Even with the advances in minimally invasive spine surgery techniques, there are some deformities and complex cases that may require a traditional, open approach or a hybrid of minimally invasive and open techniques.
Each case is evaluated on an individual basis to determine the most appropriate surgical technique to bring about the greatest benefit to the patient. The cases below offer unique challenges to spine surgery:
Kyphosis refers to an exaggerated curvature of the spine, resulting in a round back. Clinically, patients note a hunchback, a forward leaning posture, and muscle fatigue after standing or walking. There are several types of kyphosis. Scheuermann’s kyphosis is an idiopathic curvature of the spine that usually evolves during adolescence, with wedging of sequential vertebral bodies. Proximal junctional kyphosis is an increased curvature due to the collapse of the disc spaces just above a prior spinal fusion. Kyphosis can also develop due to arthritic changes in the spine, fractures, trauma, tumors, or neuromuscular disorders.
Flat Back Syndrome refers to symptoms associated with an abnormal straightening of the spine, most often due to the loss of normal lumbar lordosis (sway back). This syndrome is often associated with patients who underwent traditional scoliosis correction with Harrington rods or patients with prior lumbar fusions with poor lordosis. Clinically, patients note that they lean forward and are unable to maintain an upright posture without taxing effort.
Pseudarthrosis is an inadequate healing (non-union) of a prior spinal fusion. Sometimes the bones do not properly heal or fuse together after spine surgery in spite of modern advances (3-5%). This may be due to osteoporosis, nicotine use, infection, or implant failure. There is a small population of spinal surgery patients whose bone does not heal for an unknown reason. Clinically, patients experience progressively worsening back pain and possibly radiating leg pain, after a period of improvement post-operatively. Non-Union is usually reflected by loosening of the hardware or sometimes even fracture of the implants. This is because the hardware will eventually weaken and fracture if the bone does not heal.
Post Laminectomy Syndrome/Failed Back Syndrome refers to symptoms of chronic, persistent pain following spinal surgeries. It can be associated with instability in the cervical, thoracic, or lumbar spine as a result of prior laminectomy decompression surgery and or spinal fusion in poor spinal alignment.