by Hannah Farrell
Our Expert Witnesses in spinal surgery specialise in the surgical management of spinal conditions resulting from trauma or disease.
Our Experts in spinal surgery have a profound knowledge of managing degenerative disc disease, spinal fractures, spinal cord pathology, and more.
With a strong understanding of appropriate standards of care and NICE Guidelines, in addition to a thorough knowledge of treatment pathways, our Expert Witnesses in Spinal Surgery can advise on causation, breach of duty, current condition, and prognosis in individuals with spinal disease or who have suffered spinal injury.
See below for a brief overview on spinal surgery. Alternatively, contact an Expert in spinal surgery to see how they can help.
Anatomy
The spine is comprised of 33 individual vertebrae, functioning to support the body and protect the spinal cord and it’s branches. The spine can be divided into:
- Cervical spine, C1 – C7
- Thoracic spine, T1 – T12
- Lumbar spine, L1 – L5
- Sacral spine, S1 – S5
- Sacrum
Along the length of the vertebral column are the longitudinal ligaments. Connecting each vertebra is the ligamentum flavum and interspinous ligament. Between each vertebra lies a cartilaginous vertebral disc.
The spinal cord begins at the base of the brain (medulla oblongata) and runs through the spinal canal of the spine, to approximately L1. The spinal cord is composed of:
- Grey matter – contains neurons receiving information from the organs, skeletal muscle, and somatosensory information;
- White matter – contains neural pathways connecting to the brain:
- Ascending tracts – transmit sensory information from peripheral nerves to the brain;
- Descending tracts – transmit motor signals from the brain to the lower motor neurones.
At each vertebral levels, the spinal cord gives off a root which innervates specific muscles and areas of the skin. The specific muscle that is innervated is referred to as the myotome. The specific area of the skin innervated by the nerve root is called the dermatome. Altered sensations or movements (limb weakness for example) can indicate a problem at the level of the nerve root i.e., a radiculopathy. A common cause of radiculopathy is a herniated intervertebral disc.
At the level of L2 the spinal cord splits into a group of nerve roots, known collectively as the cauda equina, that extends into the coccygeal spine. The cauda equina has control over sensation in the saddle area, bowel and bladder function, lower limb sensation and movement, and sexual function.
What is Spinal Surgery?
Spinal surgery can be performed for a variety of reasons:
- Herniated intervertebral discs;
- Spinal stenosis;
- Spondylolisthesis;
- Vertebral fractures; and
- Degenerative disc disease.
Kyphoplasty
This is surgery to repair pathological fractures of the vertebrae caused by osteoporosis.
Spinal Laminectomy
Spinal stenosis leads to narrowing of the spinal canal causing pain, numbness and weakness. A spinal laminectomy can be performed to open up the spinal canal and alleviate pressure on the spinal cord.
Discectomy
When an intervertebral spinal disc ruptures (herniates or prolapses), surgery can be performed to remove the disc and alleviate the pressure on the nerve root and spinal cord.
Foraminotomy
When the spinal cord branches off, the nerve roots exit through foramina (holes) in the vertebra. A foraminotomy is performed to enlarge these foramina and reduce pressure on the nerve root.
Nucleoplasty
In individuals who have a mildly herniated disc, laser surgery can be performed. Radiofrequency energy is delivered through a needle into the disc causing vaporisation of tissue, thus reducing the size of the disc and the pressure on the nerves.
Spinal Fusion
Also known as spondylodesis, spinal fusion surgery is performed to create stability of the spine. The intravertebral discs of a specific section of the spine are removed, and the vertebrae are fused together.
Disc Replacement
Often used as an alternative to spinal fusion surgery, the intravertebral discs can be replaced with artificial discs.