Posterior osteosynthesis and decompression
What is it?
Posterior osteosynthesis and decompression represent a cornerstone in modern spinal surgery, offering a versatile and effective solution for a range of complex spinal disorders, including spinal instability, fractures, tumors, degenerative conditions, and deformities. The technique involves stabilizing the spine (osteosynthesis) using hardware like rods and screws, combined with decompression of neural elements when spinal stenosis or nerve root compression is present.
Postoperative care involves pain management, physical therapy, and, in some cases, the use of braces or supports. Long-term follow-up is essential to monitor the fusion process and the integrity of the hardware.
Procedure
The procedure begins with a midline posterior incision. The extent of exposure depends on the number of vertebral levels involved. Subperiosteal dissection is performed to expose the laminae and facet joints.
Osteosynthesis involves the placement of pedicle screws into the vertebral bodies. These screws are then connected with rods, creating a stable construct that immobilizes the affected segments of the spine. This stabilization is crucial in cases of spinal instability, whether due to trauma, degeneration, or surgical intervention (like laminectomy).
Decompression, often performed alongside osteosynthesis, may involve laminectomy (removal of the lamina), foraminotomy (widening of the nerve root foramen), or facetectomy (partial removal of the facet joints). The choice and extent of decompression depend on the nature and location of the spinal compression.
The precision in screw placement is critical to avoid injury to the spinal cord, nerve roots, and surrounding vascular structures. Intraoperative imaging, such as fluoroscopy, and neuromonitoring are routinely used to enhance surgical accuracy and safety.