The fundamental goals of spinal surgery are decompression of neural tissue, stabilization
of unstable spinal anatomy, and correction of deformity.

Decompression
Decompression involves the surgical removal of any material that places undue pressure on neural tissue, such as the spinal cord, nerves, nerve roots, and cauda equina. Spinal surgeons perform a variety of procedures to achieve neural decompression. Selection of the optimal surgical procedure depends on patient pathology (the structural and functional changes that led to the patient's neurological dysfunction), the level or levels of the spine affected, the patient's medical history, and the surgeon's training.

Foraminotomy is a surgical procedure that involves opening the neural foramen — the space in the vertebra where a nerve root exits the spinal canal. The term foraminotomy is derived from the Latin words foramen (hole, opening, aperture) and -otomy (act of cutting, incision). A foraminotomy is performed to relieve the symptoms of nerve root compression in cases where disc degeneration, for example, has caused the height of the foramen to collapse and result in a "pinched nerve."

Laminoplasty is a surgical procedure that involves reconstruction of the lamina — the bony plate that covers the posterior arch of a vertebra — to increase the amount of space available for the neural tissue. The term laminoplasty is derived from the Latin words lamina (thin plate, sheet, or layer) and -plasty (molding, forming). Laminoplasty or laminectomy is performed to relieve the symptoms of spinal stenosis — narrowing of the spinal canal. Laminectomy is a surgical procedure that involves removing the lamina to increase the amount of space available for the neural tissue. The term laminectomy is derived from the Latin words lamina (thin plate, sheet, or layer), and -ectomy (removal). Some cases only call for a laminotomy. Laminotomy is a surgical procedure that involves removing part of the lamina. The term laminotomy is derived from the Latin words lamina (bony plate that covers the posterior arch of the vertebra) and -otomy (act of cutting, incision).

Discectomy is a surgical procedure that involves the removal of all or part of an intervertebral disc. The term discectomy is derived from the Latin words discus (flat, circular object or plate) and -ectomy (removal). A discectomy is performed to relieve the symptoms of a herniated, bulging or slipped disc. Microdiscectomy involves the use of a microscope in performing the disc excision. By providing magnification and illumination, the microscope allows for a limited dissection.

Corpectomy is a surgical procedure that involves removing part or all of a vertebral body. The term corpectomy is derived from the Latin corporal (relating to, or affecting the body) and -ectomy (removal). Corpectomy is performed to relieve the symptoms of spinal tumors or severely fractured vertebral bodies.

Stabilization
Pathological changes or trauma to the spine can lead to instability. Degeneration of the intervertebral discs, for example, can cause vertebrae to collapse. In this case, the goal of spinal surgery is to stabilize the affected vertebrae, restore disc height, and eliminate motion.

Spinal fusion (arthrodesis) is a surgical procedure that involves placing bone graft material between two or more opposing vertebrae to promote bone growth between the two anatomical structures. The material functions as a bridge between the vertebrae where the new bone must form for a successful fusion to occur. Two types of bone graft material have been traditionally used in spinal fusion surgery: bone originating or derived from sources in the same individual, such as the patient's pelvis (autograft), and bone harvested from a donor (cadaveric bone, or allograft). As an alternative to bone graft, spinal surgeons are now using bone morphogenetic protein, the genetically engineered version of a naturally occurring protein that is capable of initiating bone growth, or bone regeneration, in specific, targeted areas in the spine.

To ensure position and rigid alignment of the vertebrae while the fusion takes place, surgeons apply spinal instrumentation, or implants (also sometimes referred to as internal fixation), such as rods, screws, hooks, cable, and wire. These implants are connected together in different configurations and are generally made from surgical-grade stainless steel or titanium alloy. Although it may be possible to temporarily immobilize vertebrae using spinal instrumentation, the instrumentation alone cannot indefinitely withstand the load: all materials ultimately fail under continuous stress. With regard to spinal surgery, therefore, permanent stabilization is synonymous with spinal fusion.

Spinal fusion and internal fixation is performed to restore spinal stability, correct deformity, and bridge spaces created by the removal of damaged spinal elements, such as vertebral discs.

Vertebroplasty is a surgical procedure that involves repairing a fractured vertebral body. The term vertebroplasty is derived from the Latin words vertebra (to turn, change) and –plasty (molding, forming). Vertebroplasty is performed to restore the stability of a vertebral body, which has fractured as a result of injury, osteoporosis, or has been damaged as a result of other lesions, such as cancerous tumors (metastases).

Correction
When viewed from behind, the human spine appears straight and symmetrical. When viewed from the side, however, the spine is curved. Some curvature in the neck, upper trunk (kyphosis or forward bend), and lower trunk (lordosis or backward bend) is normal. These curves help the upper body maintain proper balance and alignment over the pelvis. The term deformity is used to describe any variation in this natural shape. One form of spinal deformity — scoliosis, for example, involves a side-to-side (lateral) curvature of the spine.

The surgical goals of deformity correction are twofold. The primary goal is to prevent the spinal deformity from progressing. Reducing the deformity is secondary.

Deformity correction involves surgically (1) realigning the vertebrae to restore the normal contour of the spine, and (2) stabilizing the spine, as described above, to maintain this alignment. The surgical procedures used to correct spinal deformity vary based on the cause, location, magnitude, and evidence of progression of the deformity. Patient maturity is also an important factor.

It is important that you discuss the potential risks, complications, and benefits of spinal surgery with your doctor prior to receiving treatment, and that you rely on your physician's judgment. Only your doctor can determine whether you are a suitable candidate for this treatment.

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