To touch up on the Instagram post from Friday (10/15/21), while discussing with patients about various spinal operations we get sidetracked with the type of operation, implants, and unique technologies to be used. However, fundamentally, the actual treatment doesn’t lie in an artificial disc or screws and rods, per se. In fact, the treatment rendering aspect of the operation comes from the decompression part of the procedure. The underlying etiology of the day-to-day spinal disorders (i.e. degenerative disc disease, degenerative joint disease resulting in stenosis) is in fact disc material, ligament, and bone growth causing narrowing of the space where the spinal cord and/or nerves traverse through. Therefore, the treatment rendering aspect of the operation is decompression.
In spine surgery, we can employ a variety of approaches (anterior, lateral, posterior, oblique, etc.) in order to adequately decompress these neural structures. Decompression in this case would be the removal of any bone, tissue, ligament that is compressing/narrowing the neural foramen (the space where the nerve root leaves the spinal cord). Depending on the approach and the amount of tissue removed to adequately achieve decompression, some sort of hardware may be necessary for structural integrity.
What this means is that the true value of a spine surgeon comes from the meticulous and detailed decompression of the spinal cord/nerves. This is the part that takes the most time during the procedure itself and it is what will ensure the patient’s symptomatic resolution/improvement and/or prevent worsening. Ultimately speaking, spinal hardware, irrespective of the type of technological advancement, will be rendered useless if adequate decompression of the neural structures is not performed.