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COMPLEX
SPINAL SURGERY
SPINAL INSTRUMENTATION
Over the last 25 years, the development of surgery of the
spinal column has been rapid, and new approaches to treatment
continue to be introduced. The driving force for this revolution
has been the synergism arising from "crosstalk"
between the separate fields of biomechanics, bone biology,
orthotics, instrumentation, and operative approach innovation.
These advances in turn have led to a corresponding increase
in the surgeon’s ability to treat a wide variety of spinal
disorders.
At SDNSI our neurosurgeons utilize contemporary strategies
for application of a variety of implants in the reconstruction
of spinal integrity.  Problems
that can warrant "complex" approaches may be traumatic,
congenital, degenerative, or cancerous in origin. In all cases
implants are placed with the expressed goal of allowing the
most optimal decompression of neural elements, while fulfilling
local biomechanical demands. This approach, when successful,
affords the best chance for early active pain free movement.
The ultimate goal of placing spinal instrumentation is the
expeditious facilitation of spinal fusion. Fusion, once obtained,
is then typically associated with a satisfactory outcome rate
of 65-93% when the surgical literature in its entirety is
surveyed. This success rate typically increases further with
a more appropriate selection of patients.
Despite these encouraging statistics, spinal fusion has shown
definite drawbacks. Fusion for one thing is not always achieved
(even with instrumentation), and the increased stress at the
adjacent non-fused levels may accelerate degenerative changes
of discs and facet joints particularly when two or more levels
are fused. These disadvantages of spinal fusion have consequently
increased interest in several new avenues of spinal surgery
in which SDNSI neurosurgeons are now actively engaged. These
avenues include the use of:
- Semi-rigid instrumentation (to reduce stresses at adjacent
normal levels of the spine.)
- Shaped memory metal alloys (to facilitate complicated
reconstructions of alignment.)
- New bone substitute materials (to decrease reliance on
harvesting bone graft from patients)
- Implantable electrical bone growth stimulators (to encourage
migration of bone forming cells into fusion sites)
- AGF (autologous growth factor) harvested from the patient’s
own blood (to encourage migration of bone forming cells
into fusion sites)
- Image guided spinal stereotaxy (to optimally place spinal
instrumentation components into anatomically challenging
locations)
Our mission demands that we continue to "push the envelope"
to discover better ways of doing complex spinal surgery.  That
is why we maintain an open exchange of ideas with the instrumentation
industry (at times as consultants). Moreover we participate
in clinical trials of new devices that merit scientific scrutiny.
These mission goals, together with the fact that we have
the only spinal fellowship trained neurosurgeon in San Diego
County, confer to SDNSI a distinctive position in the marketplace.
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