The spine is the basic and important part of the body skeleton that extends from the head to the pelvis. In fact, the body, with the spine, can move as well as be straight when standing. It supports an important structure called the spinal cord. The anatomy of the spine consists of 24 vertebrae, each of which is a bone.
These 24 vertebrae of the spine are mobile vertebrae. The vertebrae are connected to each other by muscles and ligaments, the combination of these ligaments and vertebrae is called the spine. When we look at the spine from the side, we see an S-shaped curve. This S-shaped shape helps to distribute the weight in the body and prevents the weight of the body from falling on one part and damaging an area. Also, the "S" curve to the column It helps the spine to withstand all kinds of stress. The reason why the spine resembles the letter S is that the cervical spine bends slightly inwards, the chest curves outwards and the curved back bends inwards. In this case, all parts need the power of other parts to function properly. So, the spine is made of four arc-shaped parts, which are:
The upper arch that is placed under the head is the cervical arch and its convexity is forward, this arch consists of 7 vertebrae. These vertebrae are named C1-C7 from top to bottom and from one to seven.
The central arch is called the thoracic part, which is convex towards the back and consists of 12 vertebrae. The thorax is formed around these 12 vertebrae. The thoracic vertebrae are named from top to bottom and from one to twelve as T1-T12.
The lower arch is the lumbar part, which is convex forward and consists of 5 vertebrae. This area bears the weight of the trunk and back pain is felt more in this area. Lumbar vertebrae are named L1-L5 from top to bottom and from one to five.
The sacrum part or sacrum is made from the joining of several small vertebrae. The sacrum or sacrum is 5 vertebrae attached together. This bone is a part of the pelvic ring, so the vertebral column is connected to the pelvis through the sacral vertebrae or sacrum.
Vertebrae of the spine move relative to each other and this movement occurs in the place of the intervertebral disc and the joints between the intervertebral processes. In this way, the vertebral column can curve forward, backward and sideways.
Creating problems for any of these vertebrae or the tissues around them causes pain, which in this article we discuss spine disorders and surgical procedures.

Spine diseases: Spine problems and back pain are among the most common diseases. Spine diseases cause different problems according to the affected part. Some of these diseases include the following problems:

Spinal deviation:
• Scoliosis
• Kyphosis (Kypho)
  Spine deformity is a disorder in which the spines have an abnormal curvature and a severe deformity. One type of it is scoliosis. Scoliosis is a curvature of the spine to the right or left, and the degree of this curvature must be more than 10 degrees. It can be called scoliosis. Because a significant percentage of people have a curvature of our spine of about 10 degrees. Scoliosis and kyphosis in adults can be caused by the deterioration of the body due to age and tearing in the lumbar region. Sometimes surgery in the past can cause this problem. Moderate deformity of the spine occurs when the joints and discs of the spine become distorted over time and can no longer maintain the spine in its normal and proper position. Pressure on the nerves and joints causes pain, and in general, the abnormal deviation of the spine does not play a role in the pain.
Another type is kyphosis, which the orthopedic doctor uses simple radiography to diagnose this disease. The first to the twelfth thoracic vertebrae form an arc that has an angle between 20-45 degrees. If this arc is more than 50 degrees, it is considered abnormal. Kyphosis or dorsal hump in the thoracic vertebral column is usually caused by the problems of a number of vertebrae, and therefore it is in the form of a uniform arc like the sign (), but sometimes the deformation occurs in only one vertebra (for example, in tuberculosis of the vertebral column) and the vertebral column is It turns into a curved shape. This condition is called hunchback or Gibosity. Sometimes kyphosis of the spine is accompanied by scoliosis. This condition is called Kypho scoliosis and the most common cause is neurofibromatosis.
  Various methods are used to treat this disorder, some of which include medication, physiotherapy, drug injection, and surgery.

                                         
 

Types of scoliosis:
1- Congenital scoliosis:

In this disease, when the child is born, one of the bones of his vertebra is not made in the form of a complete vertebra and is actually a half vertebra. Therefore, this type of scoliosis is diagnosed during infancy or infancy, and it usually progresses rapidly, and as the child grows older, his scoliosis also becomes larger.
2- Infantile scoliosis:

These types of scoliosis do not have congenital causes. That is, the diseased vertebrae have a normal structure, but due to some reasons, they suffer from curvature and rotation of the vertebral column. This type of scoliosis is also called infantile scoliosis and is subject to progress. So

The difference between congenital scoliosis and infantile scoliosis is that in congenital scoliosis one of the vertebrae is half formed, while in infantile scoliosis the vertebrae are completely formed. In general, both types of scoliosis are diagnosed at a young age, and the progression of congenital scoliosis is higher than that of infantile scoliosis.

3- Young scoliosis:

This type of scoliosis is the most common type of scoliosis and its cause is unknown and is called idiopathic scoliosis. It is usually diagnosed between the ages of 12 and 16.

4- Adult scoliosis:

This type of scoliosis is diagnosed after puberty and after the age of eighteen. If it is diagnosed in people under 55 years old, it is usually idiopathic scoliosis that was diagnosed late, and if a person develops scoliosis after the age of 55, it is a degenerative type of scoliosis. is named. That is, due to the wear and tear of the vertebral column, the vertebral column gradually moves out of the vertical position and curves to the right or left.

Types of kyphosis (Kypho):
 

:Postural kyphosis

The most common type of kyphosis is the spine and it is actually a type of increased arch that is naturally present in the thoracic spine. This complication is more common in teenagers and more in girls. These patients are usually young and obese girls who do not have much movement and physical activity. Another cause of postural kyphosis is hip joint diseases. If for any reason (for example, bilateral dislocation of the hip joint) the hip joint in the pelvis area cannot be fully opened, the patient has to rotate his pelvis forward to stand, this forward rotation of the pelvis increases the arch of the lumbar spine and the spine The chest, which is on top of the lumbar spine, creates an arch in the opposite direction to compensate for it, which is thoracic kyphosis. This disease is rarely painful. Postural kyphosis rarely causes problems in adulthood.

 

:Scheuermann Kyphosis

Scheuermann is the name of the Danish radiologist who first described this condition. This disease also occurs in adolescents with the age of 10-16 years, which is the age of puberty, and usually the severity of the vertebral arch in this disease is more than the previous type of kyphosis. The problem of these patients, apart from the change in the shape of the spine, is the pain that may increase when standing and sitting for a long time. Of course, the intensity of pain usually increases during physical and sports activities. It improves spontaneously even without treatment after the end of puberty. A simple radiograph of the vertebrae of these patients shows a change in shape, so that several consecutive vertebrae are seen as wedges instead of being cylindrical, and the height of the vertebrae in the front is lower than in the back.

: Congenital Kyphosis

In this type of kyphosis, the spine of the fetus is not well formed while it is in the mother's womb. It is possible that two or more vertebras are stuck together on one side or one vertebra is incompletely formed, as a result of which the vertebral arch gradually increases after birth with the growth of the baby.

:Ankylosing spondylitis

Ankylosing spondylitis is a type of spinal rheumatism that can cause kyphosis.

 :Destruction or deformation of the bone

This shape change can be caused by fracture or infection or tumor of the vertebra or due to osteoporosis.

 :Weakness of spinal muscles

This condition can be caused by diseases such as muscular dystrophies, polio and cerebral palsy. In these cases, the muscles around the spine do not have enough strength to keep it straight and straight.
The last step in the treatment of spinal deviations is surgery, which uses special metal devices in the form of screws, hooks and rods to straighten the spine and keep it in the same position.

:Displacement of vertebrae or spondylolisthesis

Dislocation or dislocation of the lumbar vertebrae or spondylolisthesis is one of the spine problems that affects the lower vertebrae of the spine. This disease, which is sometimes confused with a lumbar disc or a cervical disc, causes one of the vertebrae in the lower part of the spine to slip on its underlying bone. Vertebral sprain is a painful condition, but in most cases it can be treated. Both conservative treatment methods and surgical treatment methods may be used. Proper exercise techniques can help you avoid this situation.
The causes of spondylolisthesis (dislocation or dislocation of the lumbar vertebra) vary based on age, heredity, and lifestyle. Children may suffer from dislocation of the lumbar vertebrae due to birth defects or injuries. However, people of all ages are at risk of developing spondylolisthesis if it runs in the family. Rapid growth during adolescence can also increase the likelihood of developing vertebral fractures.
The symptoms of spondylolisthesis are different. People with mild cases may not have any symptoms. However, those with severe cases of sprained vertebrae may not even be able to perform daily activities. Some of the common symptoms are: constant back pain - stiffness in the back and legs - pain when touching the lower back - pain in the thigh - tightness in the hamstrings and gluteal muscles.
Several types of lumbar disc herniation occur in adults, and spondylolytic and erosive (degenerative) types are more common than others. Other types of vertebral dislocation, such as vertebral slippage due to a tumor or severe new fracture, are not so common.
• Dysplasia frustration
• Ischemic depression
• Erosive and destructive frustration
• Traumatic frustration (caused by trauma)
• Pathological frustration
Dysplasia vertebra frustration: a

This type of frustration occurs as a result of the improper formation of the lumbosacral junction, which leads to the small and abnormal normalization of the facet joints. This is a congenital condition, in some rare cases it progresses rapidly and leaves severe neurological deficits. In addition, dysplastic depression is more difficult to treat than other types.
It is difficult to treat this condition because the improper formation of the posterior and transverse ridges leaves a very small area for fusion (joining or drying the vertebra).
Ischemic vertebral fracture: The most common type of vertebral fracture is ischemic vertebral fracture, which mostly occurs in children and adolescents aged 6 to 16 years. In many cases, this complication is not accompanied by any special symptoms. Vertebral slip usually occurs shortly after the onset of the complication, but rarely progresses unless provoked by excessive strain or trauma. This is why ischemic stroke is so common in athletes, such as weightlifters and gymnasts, whose activities require intense stretching.
Erosive Vertebral Frustration: Erosive Vertebral Frustration is generally common among the elderly with inflammatory joint diseases (arthritis) and facet deformity, which are two complications that are the result of cartilage degeneration and aging. The vertebrae are placed in a horizontal position due to the deformation of the facet, and in this way it becomes easier for the gentle sliding of the vertebra. Erosive complications, like many ischemic cases, are often asymptomatic. Symptoms appear or worsen due to trauma or other spinal diseases such as spinal stenosis. If this type of frustration is accompanied by spinal canal stenosis, the possibility of using more serious treatment methods such as surgery increases.
Traumatic Vertebral Dislocation: Traumatic Vertebral Dislocation is very rare and usually associated with acute fracture of parts of the spine. Lower facet injuries can be treated like other spinal fractures.
Pathological vertebral dislocation: this type of dislocation, like the traumatic type, occurs rarely and only after metabolic bone disease or metastasis or as a result of diseases such as Paget's bone disease, tuberculosis or giant cell tumors. This rare species sometimes becomes very serious and the patient must be treated quickly.

Vertebral slippage is easily detected on radiographs. A lateral radiograph (from the side) shows forward sliding of one vertebra relative to the adjacent vertebra. Spondylolisthesis is graded according to the percentage of vertebra slip compared to the adjacent vertebra. The degree of slipperiness of the nut is as follows:
First grade: slip up to 25%
• Grade 2: Slip between 26-50%
• Grade 3: sliding between 51-75 percent
• Grade 4: sliding between 76-100 percent
• Grade 5 or spondyloptosis: the vertebra has completely fallen over the adjacent vertebra.
If the patient complains of pain, numbness, tingling or weakness in the leg, further investigations should be done. These symptoms can lead to the narrowing of the spinal canal or the narrowing of the space where the nerve roots of the legs are located. A CT scan or MRI can help diagnose nerve compression due to slipped vertebrae. If the bone is active at the site of the defect, a PET scan is performed for a more accurate diagnosis.
The initial treatment of spondylolisthesis is conservative and is recommended based on the patient's symptoms. The usual procedure for treating slipped vertebrae is as follows:
• A short period of rest or avoiding activities such as lifting, bending, and exercising will help reduce symptoms.
• Physical medicine increases the range of motion of the lumbar vertebrae and hamstrings and also strengthens the central abdominal muscles.
• Anti-inflammatory drugs reduce pain by reducing muscle and nerve inflammation.
• Steroid injection (cortisone) in the epidural space is useful for patients with pain, numbness and tingling in the legs.
• Hyperextension brace is recommended for patients with ischemic spondylolisthesis. This brace pulls the lumbar vertebrae and brings the two parts of the involved vertebrae closer together to correct the condition of the vertebrae over time.
• Home treatments for spondylolisthesis are similar to those for low back pain and include heat therapy, ice therapy, and over-the-counter pain relievers, such as acetaminophen (Tylenol) and anti-inflammatory medications.

If conservative treatment does not help relieve the symptoms, surgery is recommended, the type of surgery depends on the type of vertebral slippage. The repair of the defective part of the vertebra or the repair of the pars bone helps to relieve the symptoms of patients with ischemic spondylolisthesis. If an MRI or PET scan shows that the bone at the defect site is active, pars bone repair will likely lead to symptom relief.

Interbody fusion: ALIF, PLIF and TLIF surgeries are performed to treat slipped vertebrae. LIF is the term for lumbar interbody fusion. The first letter in the three surgical methods indicates the method of vertebral fusion - front, back and transforaminal (side).
All three ALIF, PLIF and TLIF surgical methods have common goals, which are:
• Relieving pressure on spinal nerves (decompression)
Aligning the vertebrae of the spine
• Stabilizing the spine
Decompression: If there are symptoms in the legs, decompression surgery is performed to relieve pressure on the nerves so that more space is available for the roots of the nerves exiting the spinal cord, decompression is often performed with fusion and, if necessary, screws to fix Nuts and welding them together are used.
During the decompression stage, the surgeon removes anything that is pressing on the nerve and causing pain. Type of decompression surgery

It depends on the structure of the spine that caused the neurological disorder. Nerve compression due to vertebra slippage originates from the following 4 factors:
• Disc herniation or protrusion
In the rupture of the intervertebral disc, a part of the annular annulus fibrosus is actually torn and its internal contents, i.e. the nucleus pulposus, find their way out. This protrusion of the internal contents of the disc is called a herniated disc. This protrusion can put pressure on the spinal cord or nerve roots and cause sciatica symptoms. A surgeon performs a discectomy to remove the part of the disc that is pressing on the nerve.
• Narrowing of the foramen
The spinal nerves leave the vertebrae in the space of the foramen and extend to different parts of the body. The forward sliding of the vertebra causes narrowing of the foramen. The surgeon performs a foraminotomy operation (creating more space for the placement of nerves in the foramen) or regularizing the vertebrae.
• Stenosis of the central spinal canal
If the spinal cord or the spinal nerves do not have enough space in the path that is stretched down along the spine in the spinal canal, the problem of spinal canal stenosis occurs. The surgeon performs a laminectomy (removal of the lamina) to create more space, the lamina can be defined as the covering on the back of the spine.
• Stenosis due to lateral retraction/gill segment
Vertebral sliding is sometimes associated with breaking and separating a part of the facet joint, which is called the Gill part. Because the detached piece puts pressure on the nerves, the surgeon performs a facetectomy to remove this piece.
Removal of disc or other structures causes instability of the spine. If the surgeon left this gap in the spine, the function of the vertebrae would be impaired and it would no longer be able to support weight or prevent wear and tear when moving. To avoid this problem, the surgeon stabilizes the spine by performing a fusion operation. The surgeon fills this gap from the front, back or side with a bone graft. Bone graft is taken from the patient's own body (autograft) or donor body (allograft). Of course, artificial synthetic materials are also used to stimulate bone growth. Over time, the bone graft is welded to the vertebra and becomes one with it. In order for the spine to be stable during fusion, the surgeon uses parts such as screws, rods, and cages to secure the spine.

Minimally invasive surgery: Minimally invasive surgery is a very effective treatment method for painful patients. Unlike old spine surgery methods that required a large incision, in minimally invasive surgery, multiple small incisions are made. Using a microscope and very small instruments, the surgeon performs decompression and fusion to treat the slippage of the vertebrae. Bleeding is less in minimally invasive surgery and this method does not require much cutting of muscles, ligaments and tendons. With this description, the hospitalization and recovery period of minimally invasive surgery is shorter.
All ALIF, PLIF and TLIF procedures can be performed minimally invasively. Many surgeons use a combination of open and minimally invasive procedures to treat spondylolisthesis, which is known as the "mini-open" method.

 

:Vertebral fracture

Spinal fractures are very diverse in terms of severity, some fractures are very serious injuries that occur due to severe collisions and require immediate treatment. Other fractures can also be the result of less severe collisions, such as minor falls, especially for the elderly, whose bone strength has decreased due to osteoporosis. Most spine fractures occur in the thoracic (thoracic) and lumbar (lumbar) spine or at the junction of the back-lumbar (thoracolumbar) joint. The treatment of these cases depends on the severity of the fracture as well as its combination with other injuries.
 

:Cause of lumbar fracture
Fractures of the thoracic and lumbar spine may result from violent collisions such as:
• Car or motorcycle accident
• Falling from a great height
• Sports accidents
• Violent cases such as gunshot wounds
Types of spine fractures:
There are different types of spinal fractures. Doctors classify thoracic and lumbar spine fractures based on the type of fracture and injury to the spinal cord. Classification of the type of fracture helps the doctor to choose the appropriate treatment.
The three main types of spinal fractures are:
• Bending
• Rotary
• Dislocation
Type of bending fracture:
Compression fractures:

In this type of fracture, the front (anterior) part of the vertebra is broken and the height of the vertebral body is reduced, but the back (posterior) part is not damaged. This type of fracture is usually stable (bones do not move) and is rarely associated with nerve damage. Compression fractures usually occur in patients with osteoporosis.
Axial burst fracture: In this type of fracture, the vertebra is damaged from the back and front and its height decreases. The cause of this type of fracture is usually sitting on the legs after falling from a great height. An axial burst fracture can sometimes lead to nerve compression. Some fractures are stable, while others are unstable (the bones are displaced).
Type of strain fracture:
Distraction/distraction fracture type: In this type of fracture, the fractured vertebra is completely separated (distraction injury). This type of fracture can occur during head-on car accidents, where the upper body is thrown forward and the pelvis is held in place by the seat belt.

Rotational fracture type:
Fracture of the transverse process of the vertebra: this sh

Abnormal stiffness occurs due to twisting or bending to the side. In these cases, the fracture generally does not cause a problem in the stability of the spine.
fracture-dislocation:

This type of fracture is an unstable injury that includes bone fracture and damage to the adjacent soft tissue. Many of these types of injuries cause spinal cord injuries.

 

Types of spinal fracture surgery:
There are three types of surgery to treat lumbar vertebrae fractures, these three types of surgery include:
Vertebroplasty of the spine:
One of the types of lumbar vertebrae fracture surgery is vertebroplasty. To perform this surgery, the patient is anesthetized while lying on the stomach on the operating bed, then the surgeon uses a fluoroscope to insert a long needle from the back of the back into the body of the broken vertebra, then bone cement which is in a liquid state, enters the body of the fractured vertebra and takes out the needle. After injection, this bone cement needs 15 minutes to solidify and hold the vertebra that was weakened by the fracture firmly. This strength will eliminate the patient's pain. In vertebroplasty, the deformity of the vertebra caused by the fracture is not corrected, and an attempt is made to stabilize the situation. Vertebroplasty, unlike kyphoplasty, does not treat the deformity of the spine and the arch that is created in the spine due to the deformity of the vertebra. Also, vertebroplasty does not prevent future fractures.
Kyphoplasty of the spine:
Spine kyphoplasty is another type of lumbar vertebrae fracture surgery, this advanced minimally invasive method has more advantages than vertebroplasty. These benefits include less cement leakage, repair and correction of the spine, increasing the height of the vertebral column and improving the biomechanics of the spine. This surgery is performed in such a way that the surgeon increases the height of the vertebra by creating a hole with expandable balloons in the center of the vertebral body, which is inserted through the needle, and by expanding the balloon theoretically, the height of the vertebral body can be increased to about before It breaks. After this, cement will be injected into it. This method of fracture stabilization can correct the lost height and the diameter of the spinal vertebra and its angle. Polymethyl methacrylate used in kyphoplasty has a higher viscosity than vertebroplasty because the cement is directed into the formed cavity.
:Spinal fusion surgery
Fusion surgery will be performed under anesthesia and in the hospital. During the operation, the patient will not feel pain. This surgery may take several hours. The surgeon prepares the bone graft material. This bone graft can be taken from the person's hip bone, artificial bone, or from a bone graft bank.
Spinal fusion surgery may be performed with a discectomy. The reason for performing a discectomy is to remove the damaged disc. When the surgeon removes the disc between the vertebrae, a bone graft is performed in that area to maintain the height of the vertebrae. Also, the surgeon uses two vertebrae to create a kind of bridge or fusion to maintain the stability of the spine in the long term. If a person has a lumbar spine fusion operation, the surgeon makes a small incision in the lumbar region and a bone graft is placed between the two damaged vertebrae. After the bone graft is placed in the vertebral column, the surgeon will use platinum and screws and special tools to keep the spinal cord stable. This work, in addition to increasing the stability of the spine, can lead to an increase in the speed of recovery and success in surgery.

 

:Disc protrusion
  Discs are rubber cushions that are located between the bones of the vertebral column and surround the spinal cord. Discs are herniated by a tear in the outer layer of the disc called the annulus or separation of the end plate from the body of the vertebral bones, allowing the gel-like center (nucleus pulposus) to leak out. This gel can compress parts of the nerve and cause pain. The protruding nucleus pulposus contains inflammatory proteins that can cause enough inflammation to affect the adjacent nerve and cause what is commonly known as sciatica or radiculopathy. Lumbar disc herniation can sometimes happen by lifting things and sometimes by itself. For example, aging can be the cause of lumbar disc protrusion, because with age, the disc becomes dry and the outer wall of the disc becomes weak. The gelatinous core of the disc protrudes from the tear created in the disc wall and its pain is caused by its contact with the nerve.

:Lumbar disc symptoms or disc protrusion
From the symptoms of disc protrusion, in some cases, in addition to the back and legs, due to the pressure of the ruptured disc on the nerves, the function of the involved nerve is disturbed. The result of this incident is the inability of the patient to move the ankle, knee or the whole leg, and in some cases it leads to urinary-fecal incontinence.
Back pain is one of the most common human problems. A number of people who suffer from back pain and subsequently experience shooting pain in their legs are suffering from lumbar disc protrusion disease. If the pain is severe and does not respond to drug treatments, and is accompanied by leg weakness or urinary-fecal incontinence, the patient will undergo surgery.
Surgical procedures for disc protrusion:
1. Closed surgery for disc protrusion:

This surgical procedure is performed by making a small incision instead of a large incision on the patient's body. Due to the small incision made in this surgery, the patient has a faster recovery period and less pain compared to open surgeries. One of the most common closed surgical procedures for disc protrusion

It can be mentioned injection in the facet joint, injection of discogel, injection through the decompressor device, etc.
2. Laser disc herniation surgery:

Lumbar disc surgery by laser is one of the safest and least invasive methods of lumbar disc protrusion surgery, which can treat pain and inflammation resulting from disc protrusion by stimulating the body's natural processes and using laser light energy.
3. Discectomy surgery:

With the help of lumbar discectomy surgery, a part of the protruding discs that puts pressure on the lumbar spinal nerves can be removed. This method is also used for the treatment of damaged and protruding discs, which are of high intensity. Discectomy surgery is one of the most specific surgical procedures for lumbar disc protrusion, which today is performed in a minimally invasive manner by creating a small incision in the lumbar region.
4. Disc laminectomy surgery:

This surgery is used for the treatment of very bulky discs, and because it may damage the nerves when the disc comes out, it is less used in disc protrusion surgeries. The most common use of this surgery is to reduce the pressure on the nerves.
5. Endoscopic disc surgery:

If the protrusion of the lumbar disc is unilateral, that is, one or two spaces in the disc are torn, in this case, this condition can be treated with the help of endoscopic disc surgery. This surgery is minimally invasive because the surgeon makes a small two-centimeter incision in the back to access the vertebrae.

How and how to perform lumbar disc herniation surgery:
For the treatment of small protruding discs, but at the same time stubborn and resistant to medical treatment, lumbar disc herniation surgery with the help of laser is recommended. This surgery does not require general anesthesia and cuts in the lumbar tissue, and in most cases, the surgery is It is done on an outpatient basis under local anesthesia. During this surgery, the surgeon inserts a thin needle into the damaged disc with the help of a fluoroscope. An optical fiber is placed inside the needle and the laser energy is radiated into the disk through the fiber, and this factor causes the jelly substance in the middle of the disk to evaporate. As a result of the negative pressure created by the laser, the pressure can be removed from the spinal cord and the pain and symptoms of the disease can be relieved. If less invasive and non-surgical treatments such as lumbar disc herniation surgery do not work or cause symptoms to worsen, the surgeon suggests a discectomy to the patient. To perform lumbar disc herniation surgery, the patient must be under general anesthesia and must be admitted to the hospital one day before the surgery. The way it is done is that after preparing the surgical site, the surgeon makes an incision in the lower back. After observing the vertebrae and intervertebral discs, the surgeon proceeds to remove the external parts of the disc and the parts that have leaked. In some cases, the surgeon may also remove a part of the bone and lamina of the vertebrae during surgery. This type of surgery is called laminectomy, which in most cases needs to be performed along with discectomy surgery.

:Tumors

 
The foundation of our human body is established on the spine; Therefore, any disorder that threatens the spine affects our human lives. One of these complications is spinal tumors, fortunately 70% of them are benign. Inside the spine, the spinal cord is located; So if these tumors grow and enlarge, they can put pressure on the spinal cord, spinal nerves, blood vessels, spinal bones and spinal cord; Any of these parts that are involved cause certain signs and symptoms to appear.
  Those tumors that directly affect the vertebrae of the spine are known as vertebral tumors. These tumors can be the result of cancer metastasis; In other words, spinal tumors develop after cancer spreads to other parts of the body, including the spine. It is estimated that in almost 30% of cancer patients, this disease spreads to the spine. Back pain caused by these tumors has characteristics, some of which are:
• This pain has a gradual onset and the passage of time makes the pain worse and more intense.
• This pain is not relieved by resting and its intensity increases at night.
• Recurrence of this pain is in the form of a sharp or shock-like pain that is felt in the upper or lower back.
• This pain usually spreads to the legs, chest or other areas of the body.
Types of spinal tumors:
The prevalence of these tumors is less compared to brain tumors and they are divided into several groups according to the location and cancerous tissue they have. Among these tumors are:
1. Intracavitary tumors:

These types of tumors grow inside the spinal cord and comprise about 20 to 30% of primary spinal tumors. Intracavitary tumors usually cause back pain that worsens when sleeping. Numbness and tingling can also be caused by this group.
2. Extracavitary tumors:

The growth site of this group of tumors is a thin bag that holds the spinal cord; So their location is outside the spinal cord. This category of tumors usually spread in the nerve roots that exit from the spinal cord. Back pain at night or pain that spreads to the arm or leg are common symptoms of this type of tumor. Usually, these types of tumors are benign, like tumors in the bone marrow; But removing them through surgery is difficult and expensive

is like And unfortunately, there is a possibility of cancer recurrence after surgery.
3. Dura mater tumors:

These tumors are very common. Their place of growth is outside the spinal cord and dura mater and they usually grow inside the bones and cartilages of the spine.
Spinal cord tumor surgery: For each type of spinal cord tumor, a special treatment method is suggested, which is discussed below.
1- Treatment of spinal tumors:

Spinal tumors are actually bone tumors. Some of these tumors are bony and basal, and others are metastatic and can spread to other areas of the body. Regarding metastatic tumors, we must say that removing the spinal cord tumor cannot cure the individual's cancer. However, advances in the treatment of these diseases, such as radiological surgery, resection surgery, and chemotherapy, have been able to solve the problems of people with these types of tumors to a large extent.
There are many treatment ways to shrink tumors or stop their growth, relieve pain and neurological symptoms caused by the tumor, and with their help the person's spinal cord remains healthy and intact. Conventional radiation therapy or radiological surgery is a way to significantly reduce spinal cord pain. In this treatment method, high-concentration rays are used so that the tumor cells face problems, and as a result, the size of the tumor will be smaller. Radiation therapy can be used to treat painful tumors. But for tumors that compress the spine and the spinal cord or make the stability of the spinal cord difficult, surgical treatment can be effective. Many benign tumors and malignant spine tumors can be completely removed from the body with the help of advanced surgical techniques.
Surgery to remove pressure from the spinal cord, called decompression surgery, involves removing part of the vertebrae involved with the tumor. When this surgery or the tumor itself leads to the loss of stability of the spinal cord, artificial bones or metal implants will be used to restore stability to the spinal cord.
2- Internal and external tumor surgery:

Surgery to remove pressure from the spinal cord, called decompression surgery, involves removing part of the vertebrae involved with the tumor. When this surgery or the tumor itself leads to the loss of stability of the spinal cord, artificial bones or metal implants will be used to restore stability to the spinal cord.
3- Primary tumor surgery:

Preliminary tumors such as astrocytoma, ependymoma and hemangioblastoma are formed inside the spinal cord itself. The common treatment for this category of tumors is surgery and their complete removal from the body. The main goal of surgery in this situation is to completely remove the tumor from the body, and of course to preserve the most nerve function in the spinal cord area. In most surgeries on the spinal cord or next to it, surgeons use precise instruments along with neurophysiological techniques such as SSEP and MEP. These techniques help surgeons to check the function of the spinal cord during surgery, and thus the operation performed will be significantly safer.
Ependymoma and hemangioblastoma are usually significantly different from the spinal cord area and usually they can be completely removed from the body. Patients may experience temporary neurological problems, but these problems usually resolve over time. On the other hand, the astrocytoma may merge with the surrounding spinal cord and its complete removal in the body will not be possible safely. Since these tumors usually have a low growth rate, removing only part of the tumor may bring better results for patients.

   

:Vertebral arthritis

 

  Arthritis is a common joint disease that occurs due to wear and tear of the body's cartilage. All joints of the body are subject to damage and arthritis. This disease affects millions of people from all over the world every year and causes pain, dry joints and impaired movement. Osteoarthritis affects different parts of the body, one of which is the spine.
Osteoarthritis of the spine, also known as osteoarthritis, is a degenerative disc disease caused by the wear and tear of the cartilage of the lumbar vertebrae in the spine. This condition often occurs due to age and cartilage degeneration and affects people over 50 years old. In this case, the person experiences pain and swelling in the lower back and has difficulty in doing the simplest daily tasks such as walking, bathing, bending, etc. In general, it can be said that any activity that involves movement of the spine is painful for the affected person and causes discomfort.
To better understand this condition, it is better to take a look at the anatomy of the spine and how it works. The spine in adults consists of 26 vertebrae that start from the end of the skull and extend along the neck and trunk, each of the vertebrae is connected to the other vertebrae at three points. The first point is in the front part of the spinal cord, which is connected by a disc, and the other two points are two small joints in the back part of the spinal cord, which are called facet joints. These joints cause the movement of the spine and allow humans to bend forward and backward by turning to both sides. When these joints are damaged due to wear and tear, they make the movement of the lumbar vertebrae difficult and cause the joints to become dry and cause pain. This disease in me

The more advanced solution also affects the nerves of the spine and by damaging the spinal cord, it will cause numbness and weakness in the legs. In general, spinal arthritis can be divided into the following two general categories:
• Degeneration of the intervertebral disc: Here, the intervertebral discs are degenerated due to old age or injury, causing the vertebrae to become dry and painful during movement.
• Spinal canal stenosis: Arthritis causes spinal canal stenosis in more advanced stages and by putting pressure on the nerves, it causes symptoms such as numbness in the legs, tingling, itching and pain, which eventually causes the inability to walk.

The causes of spinal arthritis can be trauma or damage to the vertebrae, overweight, as well as heredity and genetic problems.
Considering the complexity and progress of the mentioned disease, the ways to treat arthritis are very diverse and wide. In other words, the process of treating the said disease includes a staircase from simple to complex steps. In this regard, experts and experts in this field have presented various treatment methods, the most effective treatment methods are: 1- Rest 2- Change in lifestyle such as exercise, weight loss, not smoking, etc. 3- Acupuncture 4-Massage therapy 5-Physiotherapy 6-Prescription of anti-inflammatory drugs 7-Effective exercise in the treatment of the disease 8-Treatment of arthritis through surgery

If non-surgical methods do not work for six months or more, it may be time to consult a neurosurgeon about surgery. The presence of some special symptoms, such as loss of urinary control or excretion due to pressure on the nerve, can indicate an urgent and urgent need for surgery. The type of surgery—and what you can expect—depends on the exact diagnosis, the symptoms and location of the degenerative disc, and your overall health. In general, those patients who do not smoke and are not obese will have better results from surgery.
Traditional surgical methods focused on the removal and removal of the disc or parts of the disc that put pressure on the nerves, and it was called decompression surgery, and the method in which fusion of the vertebrae took place to gain control of movements was called surgery. They knew stabilization. Most of these processes occur simultaneously. The neurosurgeon will examine different options for pressure reduction and stabilization. These can include processes involving the facet joints, bone spurs, and all or part of the lamina, the bony plate that supports the spinal cord. When the lamina compresses the spinal cord, it can cause a lot of pain. These techniques are performed from behind the spine (posterior part).
Other decompression surgeries are performed from the front of the spine (anterior section), because the spinal cord is in the way. One option is a discectomy (removal of part or the entire disc) using a minimally invasive approach, making incisions with small instruments and a short recovery period. Another option is a corpectomy or vertebrectomy, in which one or more vertebrae that are causing pressure are removed and the empty space is filled with bone from another location.
 
In addition to the types of spine diseases that we discussed, there are also some rare diseases that cause pain and damage to the spine, such as cauda equina syndrome and syringomyelia.
Cauda equine syndrome or Cauda equine syndrome
Nerves that originate in your spine behind your back help your brain control your legs and other pelvic organs. A herniated disc, fracture, or other problem can put pressure on this group of nerves called the cauda equina, causing this rare but dangerous condition. Urgent surgery is needed to resolve sensory motor problems or bladder and bowel control.
 
 
:Syringomyelia
In rare cases, a fluid-filled sac called a cyst can form in your spinal cord. This problem can happen when brain tissue from your skull pushes against the spinal cord, or from an injury or tumor. Syringomyelia may not cause special problems, but if the cyst is continuously growing, it can damage the spinal cord and require surgery.

Now, in the continuation of this article, we will talk about spinal surgery methods.
Spinal surgery procedures
Discectomy or microdiscectomy:
In this surgery, the intervertebral disc herniation is removed to remove the pressure on the compressed nerve. Microdiscectomy surgery is one of the minimally invasive spine surgeries.
Laminectomy:
In this surgery, the thin bony plate behind the spine or lamina is removed. This work increases the space between the spinal canal and reduces the pressure.
Laminotomy:
In this surgery, a part of the lamina vertebral arch that covers the spinal cord is removed by the surgeon. In this surgery, a smaller amount of bone will be removed than in lainectomy surgery. Laminectomy and laminotomy methods are decompression surgery methods. In these surgical methods, the compression of the spinal nerves is resolved by the tissue.
Foraminotomy:
In this surgical method, the tissue or bone that forms the passage where the nerve roots branch off from the spinal cord and exit the spine will be removed.
Disk replacement:
Artificial disc replacement is shown to be very effective for severe degenerative disc patients. Degenerative disc disease is a disease that can cause significant pain in the back and neck. In this surgery, an artificial disc will replace the damaged disc. This method will be used as an alternative method for welding beads.
Welding the beads:
In this surgical method, two vertebrae are welded together. In this surgical method of tools

Special bone grafts such as rods, screws, etc. are used. There are different methods of bone grafting. Methods such as the individual's own bone graft and another individual's bone graft. Bead welding is done with different approaches.

ALIF, PLIF, TLIF, LIF surgeries
This surgery is related to the fusion of the lumbar vertebrae, which will be used to stabilize the vertebrae of the spine and eliminate movement between the bones.
• Fusion of the front lumbar vertebrae
• Fusion of the posterior lumbar vertebrae
• Lumbar intervertebral fusion, which is created in the process of this hole surgery method in the desired area.
• Lateral intervertebral fusion, which is surgically performed using a minimally invasive approach on the lateral part of the body
Minimally Invasive Spine Surgery (MIS)
Minimally invasive spine surgery (MIS) was first performed in the 1980s, but there have been rapid advances recently. Advances in technology enable spine surgeons to patient-select and treat an evolving array of spine disorders, such as degenerative disc disease, disc herniation, fractures, tumors, infections, instability, and deformity.
  MIS was developed to treat spinal disorders with less muscle involvement. This can lead to faster recovery, less blood loss during surgery, and a faster return to normal function. In some MIS procedures, also known as "keyhole surgery," the surgeon uses a small endoscope with a camera attached to the end. This endoscope is inserted into the skin through a small incision. The camera provides surgeons with a view of the inside of the body and allows access to the damaged area of the spine.
Possible risks of surgery:
Like any surgery, spine surgery can have risks. It should be remembered that these are the only possibilities that patients must be aware of because they are sometimes effective in solving or preventing some events.
The most important damage that can be caused during spine surgery is damage to the nerve roots that come out of the spinal cord. Depending on which nerve roots are damaged, the symptoms are variable. When the nerves that go to the intestine and bladder are damaged, the patient may lose control of his urine or stool. Damage to the nerves that go to the genitals may cause disorders such as impotence in a person. Damage to sensory nerves can cause limb pain, numbness, tingling, and murmurs, and damage to motor nerves can cause weakness in one or more limb muscles.
Other possible injuries include hematoma. Hematoma means the accumulation of blood in one place. Due to the continued bleeding from a vein, a lot of blood may accumulate around a nerve and the pressure of this blood accumulation may disrupt the function of the nerve.
 
Some complications of spine surgery can be seen in certain surgeries. For example, it may be necessary to have a bone graft around the vertebrae. This bone graft is usually taken from the hip area. Sometimes, the patient's pelvis may have pain for several months in the area where the bone was removed

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