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Spinal Surgery

Views: 1     Author: Site Editor     Publish Time: 2022-10-14      Origin: Site

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Changzhou Meditech Technology Co., Ltd., located in Changzhou Science & Education Town, Jiangsu province,isspecialized in manufacturing orthopedic implants and instruments.

After more than 10 years research and development, We have 10 main product series and they are spinal system, intramedullary nail system, trauma plate and screw system, locking plate and screw system, CMF system, external fixator system, medical power tool system, general surgical instruments system, sterilization container system and veterinary orthopedic system.

As an exporter of medical devices with more than ten years of experience, and with CE and ISO certificates, our products have been exported to many countries like the USA, Germany, Argentina, Chile, Mexico, India,Thailand, Malaysia, Turkey, Egypt, South Africa, Ivory Coast, etc.

In the principle of "quality first, service first, R&D first, innovation first", our company wins an excellent reputation both in domestic and abroad. The company takes benefting patients as its permanent goal and makes unremitting efforts for human health.

Spinal Surgery

There are many kinds of spinal surgery, mainly minimally invasive and open. Some lumbar fractures, disc herniation, spinal tuberculosis, scoliosis can be treated surgically. Minimally invasive surgery mainly includes: vertebroplasty, radiofrequency ablation, endoscopic nucleus pulposus removal, percutaneous pedicle screw rod internal fixation, etc. Open surgery mainly includes open reduction and internal fixation, laminectomy, open decompression and internal fixation, etc. And we will introduce these one by one:

A. Cervical spondylosis

For the operation of cervical disc herniation, cervical spondylotic myelopathy, and ossification of the posterior longitudinal ligament of the cervical spine, some hospitals or doctors only carry out anterior surgery or posterior surgery. In fact, there are many types of surgery to choose from. People have a lot of successful experience in these types of surgery, which can be reasonably used according to different conditions, without any technology, conditions, and narrow ideas, and give full play to the respective advantages of different types of surgery. For complicated cervical spondylosis, decompression and fixation through both anterior and posterior approaches can significantly shorten the hospitalization time, and the effect of complete decompression is better.

  • Anterior cervical decompression and fusion with bone graft and internal fixation:

It is applicable to cervical spondylosis with protrusion of intervertebral discand short compression segments (1-3 spaces) of spur vegetation. It has the advantage of direct resection of the lesion, which is relatively simple and convenient. It is the most common routine operation and the basic method for treating cervical spondylosis.

  • Posterior cervical decompression and laminoplasty:

It is applicable to the cervical spondylosis with the number and segment of intervertebral disc compression and spinal canal stenosis, as well as severe anterior compression (ossification of posterior longitudinal ligament, intervertebral disc). It belongs to indirect decompression, which has the advantage of preserving the cervical motion function and is relatively safe.

  • Artificial cervical disc replacement:

It is applicable to patients under 60 years of age with short segment anterior intervertebral disc compression. While decompressing and relieving the compression of spinal cord, it retains the function of cervical spine, reduces the possibility of accelerating the degeneration of adjacent segments, so that patients can move earlier after surgery and the function is closer to the physiological state.

  • First stage anterior and posterior cervical decompression and fixation

Decompression is complete and safe, suitable for severe and special cervical spondylosis. For the cases of cervical spondylotic myelopathy with clamp type or long segment spinal stenosis and huge anterior compression, there are some limitations in either anterior or posterior surgery alone. We take the prone position for posterior surgery, and then take the supine position for anterior surgery, and the first stage anterior and posterior decompression.

Advantages: After posterior decompression, the cervical spinal cord can drift to the rear, the space in front of the cervical spinal cord is relatively increased, and the pressure in the spinal canal is reduced, reducing the risk of anterior surgery. At the same time, the bilateral compression is relieved, the decompression is complete, the effect is obvious, and it is helpful for the recovery of spinal cord function; it reduces the pain of patients and is easy for patients to accept. It avoids the disadvantages of twice hospitalization, the second surgery, long course of disease, and saves hospitalization costs.

  • Posterior cervical foraminal decompression and discectomy

Compared with anterior approach, posterior cervical foraminal decompression does not require bone graft fusion and does not lose the range of motion of the cervical spine. The posterolateral cervical disc herniation nucleus pulposus removal via the posterior approach is performed under direct vision and is relatively easy, so it is safe and reliable. Indications: posterolateral cervical disc herniation, single level intervertebral foramen stenosis, multi level intervertebral foramen stenosis without central spinal canal stenosis, and persistent root symptoms after anterior discectomy and fusion.

  • Surgery for upper neck disease

Injuries and diseases of the upper cervical spine can cause serious spinal cord dysfunction. Due to the complex anatomical structure, most hospitals cannot treat them. For example, atlantoaxial fracture and dislocation, atlanto occipital malformation, and rheumatoid upper cervical spondylopathy, anterior release and posterior fixation can be used to reduce dislocation, relieve spinal cord compression, and save lives.

B.Lumbar disc herniation, lumbar spinal stenosis, lumbar spondylolisthesis, discogenic low back pain

Intervertebral fusion does not require pelvic bone removal for lumbar spinal stenosis or lumbar spondylolisthesis caused by various reasons. The first purpose of the operation is to decompress the nerves. When the spine is unstable, the spinal fusion is determined according to the degree of instability and spondylolisthesis. The posterolateral spinal bone graft (PLF) or interbody bone graft (PLIF) is selected according to whether it is suitable for pedicle screw internal fixation. In PLIF, the whole extracted vertebral arch and inferior articular process complex (median incision) are used as the interbody bone graft fast, which not only obtains the best bone graft material, but also avoids taking bone from the pelvis or having to purchase an interbody fusion cage, which eliminates the complications of bone removal and greatly reduces the operation cost.

  • Lumbar disc herniation

According to different pathological types, fenestration of nucleus pulposus, laminectomy and discectomy (sometimes with bone graft fusion and internal fixation) and artificial disc replacement are selected.

  • Lumbar spinal stenosis

Decompression of spinal canal and nerve root canal is feasible. For patients with spinal instability, dynamic fixation or fusion fixation should be performed selectively, so that patients can achieve the treatment goal at the minimum cost and obtain satisfactory results.

1) Dynamic fixation of lumbar spine - it not only stabilizes the spine, but also retains the function of lumbar motion. Its advantages include: (1)it can significantly reduce the pressure of intervertebral disc and prevent the degeneration of intervertebral disc; (2)The elastic connection maintains and restores the three-dimensional balance of the motion segment.

2) Minimally invasive spinal canal decompression surgery with muscle integrity preserved - an advanced surgical method introduced from abroad. After further improvement, the operation has a small incision, does not peel muscles, retains the shape of ligaments and vertebrae, and decompression under magnifying glass and microscope is fully reliable, does not damage the stability of the spine, and has a light postoperative response. Patients can walk on the second day, and leave hospital 5-7 days later.

  • Lumbar spondylolisthesis

It is the best indication for decompression and reduction, bone graft fusion, and pedicle internal fixation. It is also the most common type of surgery using titanium plate fixation. The operation is difficult and large in scale. The cause or early stage of spondylolisthesis, lumbar spondylolysis, is much easier to deal with in time.

1) Lumbar spondylolysis may be caused by fatigue fracture of a part of the lumbar spine (isthmus, small joints) due to repeated exercise. If it does not heal, in order to prevent lumbar spondylolisthesis, especially when the symptoms are obvious, bone graft can be used to repair the isthmus, two screws and a titanium cable, which is simple and safe.

2) Lumbar spondylolisthesis was treated with surgical open reduction, intervertebral bone graft fusion (PLIF), and pedicle internal fixation. The first purpose of the operation is to decompress the nerves. When PLIF peek lumbar fusion cage is performed, the whole vertebral cage arch and inferior articular process complex (median incision) are used as a quick interbody bone graft, which can not only obtain the best bone graft material, but also avoid taking bone from the pelvis or having to purchase an interbody fusion device (interbody fusion cage), eliminate the complications of bone removal, and greatly reduce the operation cost.

  • Discogenic low back pain

Dynamic lumbar fixation, artificial disc replacement and interbody fusion (anterior or posterior) were selected.

C. Spinal fracture

From upper cervical vertebra fracture to lumbosacral vertebra fracture, anterior or posterior decompression and fixation of the spine are adopted.

1. Intraoperative myelography and transpedicular decompression

In the open reduction, decompression and internal fixation of thoracolumbar burst fracture, the decompression effect can be effectively monitored to reduce iatrogenic injury.

2. Minimally invasive percutaneous kyphoplasty for the treatment of vertebral compression fractures in the elderly

Only one needle of bone cement can be injected. It is a real minimally invasive technology to relieve pain and walk out of bed 1-3 days after surgery.

D. Minimally invasive spine surgery

A. The goal of minimally invasive spine surgery (MISS) is to achieve the effect of conventional surgical treatment and reduce the surgical trauma as much as possible, so as to reduce the incidence of complications, intraoperative bleeding, hospital stay, etc., so that patients can recover and return to normal life and work as soon as possible.

Mainstream minimally invasive surgery includes:

1. Endoscopic technology

Spinal endoscopy refers to that the surgeon, under the guidance of X-ray or navigation during the operation, uses puncture expansion tools to puncture from the skin to the spinal lesions, establishes endoscopic and surgical operation channels, uses water as the medium, magnifies and displays the internal results and lesions on the high-definition display screen through the endoscopic system, and the doctor operates through the screen image. The most commonly used surgical methods include: lateral lumbar foraminal endoscopy, posterior lumbar lamina approach endoscopy, and posterior cervical endoscopic surgery. Compared with traditional surgery or microsurgery, it has the following advantages: (1) Wide indications, small bleeding and trauma, no damage to the normal spinal structure, and the incision is generally less than 1 cm; (2) Operation under local anesthesia can be selected, and real-time communication between doctors and patients is available to facilitate operation and avoid intraoperative nerve injury; (3) Less complications, fast recovery, can get out of bed after surgery, discharge in 1-2 days, or outpatient surgery; (4) Low infection rate; (5) The long-term problem of accelerated degeneration of adjacent segments in early fusion is avoided. Disadvantages include: (1) There is a certain recurrence rate. Once the recurrence occurs, reoperation will be more difficult and risky due to the scar adhesion of the first operation. (2) There are some complications, such as residual nucleus pulposus compression, dural and nerve root injuries, intervertebral space infection, bleeding, postoperative sensory abnormalities; (3) The surgical indications are relatively single, mainly for the treatment of simple intervertebral disc herniation. For complex intervertebral disc herniation or combined spinal stenosis, it can also be treated. If the effect is poor, open surgery is required again.

2. Minimally invasive fusion and internal fixation technology

Lumbar fusion and internal fixation is a basic surgical technique for the treatment of lumbar disorders. Through the anterior, anterolateral, lateral, posterolateral and posterior approaches of the lumbar spine, bone grafting or fusion cage, facet joint and intertransverse process are implanted in the intervertebral space, so that bone bonding between the lumbar joints can occur, thus establishing and maintaining the stability of the lumbar spine. Theoretically, the surgical segment will not recur. The minimally invasive fusion and internal fixation techniques include minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and minimally invasive lateral lumbar interbody fusion (LLIF). LLIF also includes vertical lateral fusion cage (DLIF) and the most popular oblique lateral fusion (OLIF). The minimally invasive fusion internal fixation technology mainly introduces special expanders and tubular retractors to reduce soft tissue damage and make the best visualization of the operation area possible. It can cooperate with the operating microscope or high-power magnifying glass to enlarge the surgical field of vision, so as to reduce the skin incision and internal tissue damage, and enable spinal surgery to implement the most effective treatment with minimal iatrogenic damage. Compared with open surgery, minimally invasive fusion internal fixation technology has better results in terms of hospital stay, blood loss, recovery time and time to return to normal life. At the same time, it can normally retain the posterior column structure of the spine, reduce muscle damage, and thus reduce postoperative pain. The minimally invasive fusion and internal fixation technology has a wide range of indications, including various spinal degenerative diseases, spinal stenosis, complex disc herniation, instability, scoliosis, etc. For patients with relatively serious conditions that are not suitable for endoscopy, such operations should be taken more often.

3. Percutaneous vertebroplasty

It belongs to minimally invasive surgery, including percutaneous vertebroplasty (PVP) and percutaneous balloon kyphoplasty (PKP). It is a technology that medical bone cement or artificial bone biomaterials are injected into the diseased vertebral body through skin puncture to strengthen the vertebral body. Applicable diseases include: 1. Osteoporotic vertebral compression fracture, which is not effective with brace or drug treatment; 2. Benign tumors or malignant metastatic tumors of the vertebral body; 3. Spinal fracture with osteonecrosis or nonunion after fracture; 4. Unstable compression fracture or multi segment vertebral compression fracture; 5. Burst fracture with intact posterior wall of vertebral body. The characteristics of this operation: 1. The minimally invasive interventional treatment under local anesthesia has a short operation time, the incision is within 0.5cm, the bleeding is 2-3ml, and the analgesic effect is clear. It has the function of relieving pain and reconstructing the biomechanical strength of bone at the same time. 2. For the elderly and frail patients, the surgical risk is small, and the potential complications caused by immobilization are avoided. 3. The postoperative recovery is fast and the hospitalization time is short. 4. Due to the timely relief of pain, the side effects and drug dependence of taking painkillers are avoided, and the quality of life is improved. 5. It significantly reduces the time for patients to rest in bed and need caregivers.

4. Robot assisted and navigated spinal surgery

Spine surgery requires doctors to operate with high accuracy, and small mistakes will lead to disastrous consequences. For example, for the lumbar pedicle screw insertion technology, during the screw insertion process, it must be ensured that the screw is placed inside the pedicle. The diameter of the lumbar pedicle is about 8mm, and the inner and lower sides of the pedicle are important nerve structures. Our screw diameter is 6.5 mm, which means that once the screw breaks through the inner and lower walls of the pedicle, serious nerve damage may result. Therefore, the accuracy and safety of screw insertion are very important. The orthopedic surgical robot and navigation system, guided by 3D images, can accurately position the screws according to the planned path, automatically or semi-automatically screw in the pedicle screws, minimize the damage to surrounding muscles and other soft tissues, and ensure the accuracy and safety of the surgery. For endoscopic technology, combined navigation can also greatly reduce the operation puncture time, soft tissue damage and discomfort of patients during the operation. The application of robot assisted and navigation spinal surgery will greatly benefit patients with spinal diseases.

In a word, minimally invasive spine technology can achieve the therapeutic purpose safely and effectively by minimizing the injury as much as possible. While achieving the same or better effect as open spine surgery, it can minimize the surgical trauma of patients, promote their early recovery, and reduce the sequela of surgery. However, minimally invasive spine surgery can not completely replace the traditional spine surgery. The specific operation plan should be determined according to the patient's condition, medical technology, communication between doctors and patients and other factors. The experience accumulation of conventional open surgery is the basis for minimally invasive surgery. When minimally invasive surgery encounters difficulties, it needs to be changed to open surgery in time to better ensure the safety of patients and the efficacy of surgery. Finally, we should remind the surgical patients that careful maintenance and scientific exercise after successful surgery are also extremely important, which can not only effectively improve the quality of rehabilitation, but also avoid recurrence or adjacent vertebral disease.

E. Spinal tumor and inflammation

Tumor, tuberculosis and suppurative inflammation of cervical, thoracic and lumbar vertebrae.

F. Conclusion

1. There is no blind area in spinal surgery

Safety and reliability are the first pursuit of spinal surgery. It mainly diagnoses and treats degenerative diseases of the spine, such as cervical spondylotic myelopathy, ossification of the thoracic ligamentum flavum, lumbar spinal stenosis, disc herniation at each segment from the cervical spine to the lumbar spine, and ossification of the posterior longitudinal ligament. In addition, it also deals with all kinds of injuries and diseases occurring in the spine, such as spinal fracture and dislocation, spinal deformity, spinal tumor (primary and metastatic), spinal tuberculosis or suppurative infection.

2. Unlimited cervical surgery

For the operations of cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament of the cervical spine, some hospitals or doctors only carry out anterior or posterior operations. In fact, there are several types of operations to choose from - anterior cervical decompression and bone grafting and internal fixation, posterior cervical laminoplasty (single door, double door), and one-stage anterior and posterior decompression and internal fixation. We have a lot of successful experience in these types of operations, which can be reasonably used according to different conditions, It is not restricted by any technology, conditions and narrow ideas, and gives full play to the respective advantages of different methods.

3. Thoracic vertebra surgery is simple and reliable

For ossification of the thoracic posterior longitudinal ligament, which is difficult and feared by many large hospitals, we performed segmental posterior decompression. For patients with anterior compression (ossification of ligaments or protrusion of intervertebral discs), the anterior decompression of the spinal cord was performed by the tunneling method to achieve 360 ° complete decompression around the spinal cord, which avoided anterior decompression through thoracotomy and greatly reduced trauma. This 360 ° decompression technique is also applied to the operation of lower limb paralysis caused by thoracic intervertebral disc prolapse and osteoporotic compression fracture.

4. Intervertebral fusion does not require pelvic bone extraction

For lumbar spinal stenosis or lumbar spondylolisthesis caused by various reasons, the first purpose of the operation is nerve decompression. When the spine is unstable, the spinal fusion is determined according to the degree of instability and spondylolisthesis. The posterolateral spinal bone graft (PLF) or interbody bone graft (PLIF) is selected according to whether it is suitable for pedicle screw internal fixation. In PLIF, the whole extracted vertebral arch and inferior articular process complex (median incision) are used as the interbody bone graft fast, which not only obtains the best bone graft material, but also avoids taking bone from the pelvis or having to purchase an interbody fusion cage, which eliminates the complications of bone removal and greatly reduces the operation cost.

For CZMEDITECH, we have a very complete product line of spinal surgery implants and corresponding instruments, the products including 5.5mm and 6.0mm spinal pedicle screw system, anterior cervical plate system, posterior cervical screw system, anterior thoracic plate system, anterior thoracolumbar plate system, titanium mesh cage, peek cage system, titanium cage, posterior cervical laminoplasty system, minimally invasive pedicle screw system and their supporting instrument sets. In addition, we are committed to continuously developing new products and expanding product lines, so as to meet the surgical needs of more doctors and patients, and also make our company more competitive in the whole global orthopedic implants and instruments industry.

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