The intent of this section is to give you an understanding of what is being done to your spine during surgery.  Spine surgery is technically challenging due to the fact there are multiple maneuvers being performed in close proximity to the spinal cord, nerves, and vascular structures.  Often the pathology that is compressing the nerves or spinal cord is severe and the anatomy is greatly distorted.  Many moves require a lot of force to move muscle and scar tissue.  Surgeons are trained to always make each move in a safe way away from the vital structures.  However, since every motion segment of the spine contains the same basic elements, the language to describe the procedures is fairly simple.

There are sections where the some of the pitfalls of different procedures are discussed.  They are presented only with the intent of giving you an idea of the surgery, not to be an exhaustive complication list.  You should be able to have a better conversation with your surgeon in regards to his or her perception of potential complications.

There are two major differences in the anatomy to be aware of in regards to the different parts of the spine.

The spinal cord is similar to brain tissue.  It is more easily injured and also does not recover as well as the peripheral nerves.  Peripheral nerves are nerves, which are located throughout the body that are in the form of cables.  They have insulation around them to enhance the conduction speed of the nerve impulses.  They are less sensitive to manipulation and have a better prognosis for recovery if damaged compared to the spinal cord.

The spinal cord ends at the first lumbar vertebra at the top of the lower back.  Surgery done only in the lower back is slightly lower risk in regards to potential nerve damage in that that there are only peripheral nerve rootlets floating in the sac of fluid called the dural sac.  The term to describe the anatomy of these nerves is “cauda equina”, which is Latin for “horse’s tail.” This difference in the nerve system anatomy allows the surgeon to retract on the nerves in the lower back to assist in taking the pressure off of them.  The spinal cord cannot be retracted without the risk of severe nerve damage.

There are three general categories of procedures that can be performed on the spine.

• Relieve pressure on nerves or spinal cord—Decompression
• Stabilize the spine—fusion
• Correct deformity