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Cervical and lumbar disc replacement surgery
Conventional spinal fusion surgery that stiffens the spine carries prolonged recovery from work and activities and is associated with adjacent level disc degeneration from added stress to the discs. Cervical and lumbar disc replacement surgery is a revolutionary treatment for people who have suffered from degenerative discs causing years of severe and debilitating pain in their spine. In this procedure, the surgeon inserts an artificial disc replacement composed of high-density plastic sandwiched between two metal plates in place of the removed disc in order regain normal motion. Grooved teeth in the plates’ outer sides keep the disc in place, as does the natural pressure of the spine.
The artificial disc helps the spine maintain its natural flexibility and shock absorption. The procedure reduces midline spinal pain, recovery times and hospital stays is much reduced as compared to fusion and it also allows for the patient to lead an active and productive life due to the maintenance of normal spinal motion with an associated lower rate of additional surgery for degeneration of adjacent disc segments. The hospital stay for disc replacement surgery is approximately 2 - 3 days. Patients can begin rehabilitation and return to daily activities with fusion surgery.
Minimal invasive / access spinal surgery
Minimal access spinal surgery (MASS) or more commonly known as ‘keyhole surgery’ has been developed with the aim of reducing ‘collateral damage’ to muscles, ligaments and soft tissues that is typically associated with traditional open spinal surgery whilst obtaining the same clinical outcomes of traditional open procedures.
The technique has been developed to complement minimal invasive spinal surgery (MISS) as this often does not allow for direct visualisation of the spine. In that regard both of these techniques DO NOT alter the indications or goals of surgery. Depending on the condition being treated, a mini-open exposure reduces the size of the wound to approximately 2 to 5 cms long, and with the aid of a self retaining frame-based retractor allows for a complete exposure of the desired area of the spine. Both MISS and MASS can be employed to treat sciatica, disc herniations, spinal stenosis, disc degenerations, tumour, trauma, tumour, infection, scoliosis, and kyphosis. Surgeries range from discectomy, decompression, disc replacement, anterior spinal fusion (ALIF), posterior spinal fusion (PLIF and TLIF), and anterior-posterior spinal fusion (AP fusion). During spinal fusion, pedicle screws and interbody cages can be effortlessly placed into the spine with the use of X-ray control and with minimal tissue damage.
The major benefits of MASS and MISS include:
Kyphoplasty and vertebroplasty
Kyphoplasty is a minimally invasive spinal surgery procedure used to treat painful, progressive Vertebral Compression Fractures (VCFs).A VCF is a fracture in the body of a vertebra, which causes it to collapse. In turn, this causes the spinal column above it to develop an abnormal forward curve, otherwise known as a kyphosis or ‘Dowager’s hump’.
VCFs may be caused by osteoporosis (an age-related softening of the bones) Osteoporotic fractures are common in the elderly and particularly in postmenopausal women, but they can also be associated with other factors such as chronic steroid usage or cancer involvement. With Kyphoplasty, the fractured vertebra is accessed through a small incision in the patients back, a hand drill is used to create a channel through which one or two balloon-like devices can be inserted into the vertebral body.
The balloons are positioned in the vertebral body and filled with a radiopaque contrast medium for visualisation. Then, the balloons are slowly inflated until the normal height of the vertebral body is restored or the balloons reach their maximum volume. The balloons are then deflated and the cavity created is filled with a cement at low pressure. This procedure is highly effective at restoring the height of the fractured vertebra, alleviating severe pain as a result of the fracture, and preventing recurring VCFs.
To download a leaflet on Baloon Kyphoplasty, please click here
The human vertebral disc is surrounded by nerves in the tissues that surround it (the annulus fibrosis). A tear in this layer, through overloading the spine, may trigger the formation of new nerve endings in the injured area and these nerves may then be irritated by the chemicals within any spinal fluid leakage resulting from a herniated disc or tear and thereby producing severe low back pain.
All discs degenerate with age but not all discs shown by MRI to be abnormal will produce low back pain. Therefore, in order to assist with a diagnosis, discography is usually performed in patients who are being evaluated to determine a specific cause of spinal pain, vis a vis, discogenic low back pain, so that a new treatment plan (possibly surgery, e.g. disc replacement or fusion) can be advocated. Because discography is an invasive procedure as it involves needles being placed into the disc, it is not performed early in the diagnostic and treatment process. Contrast, a liquid that shows up on X-ray, is injected under pressure into the centre of each disc in order to reproduce the pain and also to evaluate the anatomy of the disc. If the disc is normal, the contrast remains in the centre of the disc and does not cause pain, whereas in an abnormal disc, the contrast spreads through the tears in the disc and reproduce the patient’s same spinal pain.
Complex revision spinal surgery
Failed back surgery syndrome or FBSS is a growing problem because of the rapid expansion of spinal surgeons. This condition refers to patients who have continued spinal pain with or without nerve pain at the level of their previous surgery. All patients having failed spinal discectomies, decompressions, fusions, disc replacements, scoliosis and kyphosis surgery fall in the FBSS category. Sometimes the condition persists immediately after surgery but can also occur months to years after their index operation. FBSS is an extremely complex problem to deal with by virtue of the fact of the multi-factorial number of conditions that can cause it. The patient needs to be fully evaluated in a comprehensive manner with MRI and CT scans, diagnostic pain studies, discography, pain management and possibly complex revision surgery. .
Deformity surgery (scoliosis and kyphosis) and complex revision surgery
Scoliosis refers to an S-shaped or C-shaped spinal deformity in the coronal plane (when looking directly at the person). Kyphosis is used to describe the condition of increased forward spinal angulation in the sagittal plane (when looking at someone from the side). Adult patients may develop scoliosis or kyphosis spinal deformities during their teenage years and become progressively worse or present afresh in adulthood due to multiple degeneration of their spinal discs. Generally, a mild scoliosis and/or kyphotic curvature do not cause significant pain or disability. However, when the deformity is progressive and/or associated with other spinal conditions, it may cause significant cosmetic problems with associated pain and disability, and therefore require extensive surgery to correct the deformity. In an adult with an unsightly and painful deformity, a critical aspect of the surgical decision-making is to determine exactly what is causing the patient’s pain and disability.
Sometimes, a scoliosis patient may have one main disc segment of nerve compression or stenosis, which may be relieved by a small microscopic (‘keyhole’) decompression surgery without correction of the spinal deformity. The surgical treatment of adult scoliosis and/or kyphosis is a spinal fusion (mending the spine bones together) with instrumentation (metal rods, hooks and screws). Surgical correction of the deformity is necessary if there is significant spinal imbalance or uncompensated curvature in either the coronal or sagittal planes. Patients with spinal imbalance report difficulty walking and standing, and major corrective surgery of the deformity should be performed so to address this problem otherwise the condition will persist or recur if a small segment of their spine is decompressed without fixation.
If the spinal curvature is very stiff or if there has been previous spinal fusion surgery, sometimes a minimal access anterior discectomy and release (incision through the stomach area or chest area) or a posterior osteotomy (cutting through the spine bone using a back incision) may be performed to mobilise the spine and facilitate adequate correction of the deformity.