SPINAL STABILIZATION IN SPINAL DISORDERS – PERSONAL EXPERIENCE

Abstract

A total number of 428 patients underwent surgical procedure due to different acquired spinal disorders. Conservative approaches were tried where it was indicated. When there was no improvement with conservative treatment then surgical procedures were adopted

It was a prospective study which was done in both Govt. and private hospitals irrespective of age & sex. Total period was from August 2002 to February, 2008. Age of the patients ranged between from 8–65 years. In this series male was more dominant than female. In this series main causes were traumatic, infective, degenerative & neoplastic disorders. Prolapsed Lumber Inter-vertibral Disc 202, prolapse cervical disc 15, unstable spinal injuries 86, Pott’s paraplegia 68, degenerative disc disease 18, spondilolisthesis 12 and neoplastic both primary & secondary were 9 cases. Fenestration & disectomy done in PLID and decompression and stabilization done in unstable spinal injuries. Instrumentation done as adjuvant to achieve early biological union of bone. In Pott’s disease when conservative treatment failed to improve, decompression and stabilization was done by thoracotomy specially in at thoraco-lumber tuberculosis. Clowards operation done in cervical disc prolapse & spinal canal stenosis. Laminectomy done in lumber spinal canal stenosis. In spondilolisthesis, laminectomy followed by stabilization done by bilateral pedicular screw fixation with or without inter-body bony fusion.

Excellent and satisfactory results were achieved in incomplete unstable injuries. No neurological improvement detected in complete injuries. Maximum Pott’s paraplegia regained their neurological function and bowel bladder dysfunction except one who recovered her one limb function full but other limb become spastic. In PLID maximum patients improved immediately after surgery. Few patients required physiotherapy after surgery and improved later on. In Spondilolisthesis patients became symptoms free after decompression and in situ fusion by instrumentation.

In complete spinal injuries no improvements were detected. Breaking of pedicular screws observed in two cases. Mal-position of screws in 5 cases observed in traumatic spinal injuries. Post operative discitis developed in 2 cases after PLID operation 2 cases required surgery second time due to recurrent PLID.

Proper selection of cases is very important in spinal disorders. In incomplete spinal injuries satisfactory results can be achieved in maximum cases but in complete spinal injuries no neurological development are achieved but for early mobilization surgery is helpful. Maximum spinal disorders can be managed conservatively but surgical intervention should be done in earliest possible time when indicated.