Surgery for Degenerative Disease

Epidural Injection

Microdiscectomy

Lumbar microdiscectomy is probably the most common spine surgery performed across the world and the same is true of our hospital. We have performed several hundred of these to good effect. The disc is approached through a small opening posteriorly and the fragments compressing the nerve root are then removed. Patients regain movement quickly and require only a short stay in hospital.

Laminectomy

In patients where there is narrowing of the spinal canal and compression of the neural structures, a laminectomy can be performed to relieve the compression on the nerves. This however poses the risk of destabilising the spine. Hence, the decision to proceed with this surgery is rare.

Lumbar Fusion

When the extent of (spinal) degeneration is severe and there is instability in the form of spondylolisthesis, we prefer a procedure known as lumbar fusion. In a lumbar fusion the spine is approached posteriorly and pedicle screws are inserted under imaging guidance into the vertebral body above and below. These screws are then connected using a rod. The intervening disc is completely excised and the disc space is filled with a cage and bone graft to achieve a solid fusion.

Surgery for tumours

Intradural tumours
Intramedullary tumours

LUMBOPERITONEAL SHUNT

This procedure is performed for a variety of conditions however the commonest indication for performing this at our institution is normal pressure hydrocephalus. One end of the the shunt is placed into the spinal subarachnoid space and the other end is placed into the peritoneal cavity. Newer shunts which contain a programmable valve are also available. Shunts allow the fluid from the spinal canal to be diverted to the peritoneal cavity in a controlled fashion allowing the resolution of symptoms.