BASIC PRINCIPLES OF SPINE SURGERY

Abstract

Any surgical exposure destroys the integrity of the patient’ body, for his own benefit. Sometimes, the spine intervention is performed for urgent life-saving indications and is guided by the Straightforward Principle. In other cases, there are no life-saving indications, but surgery aims to restore function and improve appearance. The first step includes careful preparation and planning of surgery. The main principle is a protection of neural structures of the spinal cord and its nerve roots. Slow incremental correction of spinal deformity is often more effective and safer than fast and dramatic one. The ultimate 3D-harmony of the whole spine as a part of the body is better than just a correction of the Cobb angle. The purpose of any surgical fusion is the achievement of 3D-balance both at the whole body level and at levels of junctional discs above and below the instrumentation. The lecture describes in details patient positioning, approaches, instrumentation and implants, main strategies for deformity correction, analysis of deformities (global and local), different ways of correction, most applicable corrective techniques (compression, distraction, translation, and axial rotation), and postoperative examination with particular emphasis on the spine alignment and the achieved balance. Each patient should be regarded as unique, and its treatment should be personalized. It is important to realize that the most effective and urgent treatment should be delivered in cases complicated by neurological symptoms.