Open surgery is the most common and oldest method of treating spine problems. All neurosurgeons, spine surgeons do open surgery and then gradually move to minimal access spine surgery in the form of tubular, endoscopic, microscopic etc.
We recommend open surgeries for spine and back disorders only when:
- Minimally invasive techniques won’t be feasible to treat the specific damaged part of your spine
- The surgeon needs to remove some tissues and bone altogether or thoroughly diagnose your condition
- Relatively larger portions of the spine need to be replaced with prosthetic fixations
- Infected spine or large tumor of the spine
Open surgeries provide a more accurate analysis of the overall conditions around the target area, and the surgeon can treat multiple vertebrae simultaneously due to larger opening. The major difference between an MIS technique and an open surgery is the size of the surface incision and the problem associated with it. Else, the goal of both surgical approaches for treating the spine remains the same.
Even though MIS techniques may seem to be technologically advanced and seamless, but an adept surgeon will always recommend a surgical option which is best suited for the patient’s condition and safety. With the same ideology, our back pain specialist in Mumbai performs the following open surgeries for his patients:
Lumbar Laminectomy Surgery:
Also known as ‘Open Decompression’, laminectomy is primarily performed to resolve two problems caused by spinal stenosis:
- Relieve neural compression and leg pain
- Reduce weakness and stiffness in the legs to improve mobility
This surgery treats multiple levels of spinal motion, along with the pain radiating in the legs. However, back pain may or may not be cured. It is performed by removing the outer bony wall of the vertebra known as the ‘lamina’ to release the compressive force exerted on the spinal cord.
The surgeon makes a single relatively long incision over the skin where the spine is compressed. Here, depending on the amount of lamina that is required to be removed, this procedure is performed in two ways:
the lamina bone from both sides of the affected vertebrae is removed along with the removal of some adjacent tissue or bone.
either half of entire lamina bone is removed over the affected vertebrae with or without removing the adjacent tissues.
After laminectomy, surgeon can perform host of surgery like clearing infection, removal of large intradural tumors, clearance of multilevel degeneration of disc, etc.
Lumbar Microdiscectomy Surgery:
A severely ruptured or herniated disc in the spine is removed via microdiscectomy to relieve the pain and pressure on the nerve root caused by that disc.
Even though it is an open surgery, microdiscectomy requires a much smaller incision to work around as compared to other open surgeries. Which is why it is performed under general anaesthesia as a daycare surgery. It is usually performed under a magnification using high power microscope.
First, with the help of retractors, the muscle tissues on the lamina on both sides of the target vertebra are moved away to make it clearly visible. In rare cases, some of the lamina bone, ligaments and muscle tissues may be removed for better visibility of the operating site, but without damaging any nerve tissues.
Now, the surgeon removes the protruding disc and its broken parts if any and the incision is closed with sutures.
Artificial Disc Replacement (ADR) Surgery:
ADR surgery is recommended to patients with aggravating degenerative disc diseases which cause chronic back pain.
Here, our spine specialist in Mumbai uses an artificial disc device which is created to mimic the strength and functionalities of a natural disc. It is typically made from a highly biocompatible biopolymer material.
Once the degenerated disc is removed, this prosthetic device is placed in the nuclear cavity of the disc. The goal of this device is to improve spinal motion and provide stability by reducing the muscle tension and pain caused by a degenerating disc.
The main problem associated with open surgery is the same as its benefit: large incision. The large incision is good for visualisation and completeness of surgery but in many patients it causes significant pain and morbidity. Patients may sometimes feel post surgery pain to be more than the pre surgery pain due to large incision. Larger incision also means delayed wound healing, increased chance of infection, later joining of work and more post operative discomfort. If there is an option of going minimal invasive, surgeon must choose MIS options for such patients.