Decompression Surgery

10
Decompression Surgery

description

Decompression Surgery. Laminectomy and Facetectomy. Discectomy. Nucleotomy. Effect of Spinal Decompression on Spinal Stability. Surgical Decompression: - PowerPoint PPT Presentation

Transcript of Decompression Surgery

Page 1: Decompression Surgery

Decompression Surgery

Page 2: Decompression Surgery

Laminectomy and Facetectomy

Page 3: Decompression Surgery

Discectomy

Page 4: Decompression Surgery

Nucleotomy

Page 5: Decompression Surgery

Effect of Spinal Decompression on Spinal Stability

• Surgical Decompression:– Removal of spinal elements that impinge the spinal cord or nerve root due to

spinal disorders, such as tumor, trauma, infection, or degenerative changes• Goals of Decompression:

– To relieve pain;– To prevent neurologic problems

• Controversies associated with decompression:– How much decompression can induce hypermobility?– When to fuse and when not to fuse?

These initiated the controlled biomechanical studies on the effect of decompression on the spinal motion.

Page 6: Decompression Surgery

Effect of Discectomy in the Lumbar Spine

• No FLX/EXT changes in patients with discectomy and minimal laminectomy

– Tibrew et al.• Evidence of hypermobility in patients (particularly female

patients) after excision of L4-5 disc– Frymoyer & Selby

• Biomechanical study showed that partial discectomy increases FLX, LB and AR motions significatly (Goel et al.)

– Flexibility test using cadavers (6.9 Nm maximum moment)– Tested Cases:

• Intact• Disc herniation (or protrusion): simulated by cutting the posterolateral part of

the AF horizontally• Partial discectomy: simulated by removing small amount of NP in addition to

partial AF removal

Page 7: Decompression Surgery

Effect of Laminectomy & Facetectomy in the Lumbar Spine

• Abumi et al.: Effect of graded facetectomy– FLX increases with uni- and bilateral medial facetectomy with

division of supra- and inter-transverse ligaments.– Total facetectomy (uni- or bi-lateral) created significant motion

increase in FLX and AR• Goel et al.:

– FLX, AR and LB motion increased in the presence of uni-lateral partial facetectomy & facetectomy.

– Additional removal of total NP increases rotational motions in all directions compared to the intact case.

– Bilateral laminectomy and facetectomy also increases the FLX and AR motions

• Clinical evidence is not as evident as biomechanical studies.

Page 8: Decompression Surgery

Effect of Decompression in the Thoracic Spine

• The vertebral body is completely removed (vertebrectomy) in most cases.

• Vertebrectomy makes the spine unstable, and the fusion and instrumentation is recommended.

Page 9: Decompression Surgery

Decompression of the Cervical Spine

• Anterior approach: Discectomy or Corpectomy– Reconstruction with an interbody graft– In case of single level surgery, the interbody grafting is

sufficient for maintaining segmental stability if the posterior elements are intact.

• Posterior Approach: Laminectomy and Foraminotomy

– Common complications of laminectomy: Development of kyphosis, instability and inadequate decompression

– In adults, laminectomy is not frequent, and it does not produce significant motion increase (biomechanical study).

Page 10: Decompression Surgery

Effect of Partial or Total Facetectomy(Biomechanical Studies of the Cervical Spine)

• Panjabi et al.:– FLX increases with disruption of all posterior structures.

– EXT increases with disruption of all anterior ligaments.

– Horizontal motion increases after removal of facet joint.

• Zdeblic et al.:– FLX and AR increase after 75% or 100% facetectomy.

– No significant motion changes after laminectomy alone or after resection of 25% or 50% of the facet.

– FLX and AR increase after more than 50% facet capsule resection after laminectomy.