Spine Injury Invasive Interventions for car accident victims, a Lecture By Dr. Craig H. Lichtblau, M.D., P.A.

Spine injuries suffered by West Palm Beach, or Delray Beach car accident victims can be treated through a number of interventions. Some are minimally invasive; others are not. Many surgical procedures are highly invasive and require disruption of many tissues in and around the spine in order to treat related pathology.

Typical invasive interventions include myelograms and discog­raphy. When diagnostic myelograms are performed, contrast is injected directly into the thecal sac so that areas of com­promise can be better visualized. Treating physicians perform discograms when the exact source or level of a patient's pain is difficult to determine. In the discogram procedure, contrast is injected directly into intervertebral discs that are considered to be possible sources of the pain. When the contrast is injected, it increases the disc pressure and therefore the neural compres­sion. The patient isn't sedated during the procedure so they can tell physicians when the patient's primary pain is created the injections. Imaging studies such as X-rays or CTs taken after the injections can also show small defects in the discs that may be filled with contrast material.3

A number of different types of injections can also be adminis­tered in order to either diagnose or treat various spinal injuries. These injections are typically a combination of anesthetics and steroids. Anesthetics are injected in order to measure the im­mediate effectiveness of the injection in a particular area. The steroids are administered in hopes to reduce inflammation of surrounding tissues in the hopes to achieve some long term pain relief. These injections typically include epidural injec­tions (around exiting nerve roots) and facet joint injections.

Spinal surgeries typically fall into categories, 1) decompressions and 2) fusions. Decompres­sions involve removing tissues around the spinal cord or nerve roots that are compressing these structures. Fusions typically involve stabilizing two or more vertebral levels to relieve com­pression of the neural structures or relieve joint pain at these levels. With most fusion procedures, there is also an element of decompression performed at the same time.

In most cases, decompressions typically involve1) laminectomies (removal of the posterior elements of the vertebra in order to relieve pressure, 2) discectomies (removal of protruding disc material, and 3) foraminotomies (removal of bone and other tissues in the area of the intervertebral foramen in order to reduce their compression).

Advances in medicine are leading to less and less invasive procedures to address typical spine pathology. Some disc injuries may be treated by electrothermal therapy, which involves cauterizing the tissues of the disc so that they partially scar and evaporate; thereby reducing the protrusion.

Endoscopic approaches to decompressions are also being performed more often. These procedures typically involve various decompressions performed though a small trocar as opposed to through a typical surgical dissection, in order to eliminate trauma to many of the tissues around the spine.

Fusions usually require more dissection and disruption of the tissues around the spine. Posterior approaches are more typical in the lumbar area. Some fusions are performed only with bone graft, but most involve the placement of some sort of hardware such as plates, screws, and/or rods.

Anterior and/or anterolateral lumbar approaches are also used on occasion. These procedures involve an incision on the anterior abdomen or flank. The abdominal organs are then retracted to the side to expose the front of the vertebral bodies.

In contrast to lower back surgeries, cervical spine surgeries are typically performed from the front. These procedures are usually referred to as "ACDF"s (Anterior Cervical Decompres­sion and Fusion) and involve retracting such important structures as the wind pipe, esophagus, and blood vessels to and from the brain in order to access the cervical disc spaces. The nerves to the vocal cords (recurrent laryngeal nerves) are particularly suscep­tible to trauma from retraction, therefore complications associated with speech are a common complication of the procedure (albeit most often the complication is only temporary).