Name of the Procedure:

Internal spinal fixation by wiring of spinous processes (also known as Spinous Process Wiring).

Summary

Internal spinal fixation by wiring of spinous processes is a surgical procedure in which wires are used to stabilize the spinal column by securing the spinous processes (the bony protrusions on the back of the vertebrae). This technique provides additional support and stability to the spine, often as an adjunct to other spinal surgeries.

Purpose

The procedure addresses spinal instability, which may arise due to trauma, degenerative diseases, or as part of a more complex spinal surgery. The goals are to stabilize the spine, reduce pain, prevent further injury, and promote proper healing of the spinal segments.

Indications

• Spinal instability or deformity
• Fractures of the vertebrae
• Degenerative disc diseases or conditions
• Patients undergoing extensive spinal reconstruction or fusion surgeries

Preparation

• Fasting typically required for a certain period before surgery (e.g., 8-12 hours)
• Consultation with anesthesiologist
• Preoperative imaging studies (e.g., X-rays, MRI, CT scans)
• Medications may need to be adjusted or temporarily halted (e.g., blood thinners)

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made over the area of the spine being treated.
3. The spinous processes are exposed, and wires are carefully placed around them.
4. The wires are then tightened and secured to stabilize the vertebral segment.
5. The incision is closed, and the area is dressed.

Tools: Surgical wires, scalpels, retractors, and other standard surgical instruments.

Duration

The procedure typically takes 1 to 3 hours, but this can vary based on the complexity of the case and whether additional procedures are performed concurrently.

Setting

The procedure is performed in a hospital or a specialized orthopedic or neurosurgical center.

Personnel

• Orthopedic or neurosurgeon
• Surgical nursing team
• Anesthesiologist
• Surgical assistants

Risks and Complications

• Infection
• Bleeding
• Nerve damage
• Non-union or failure of the fixation hardware
• Pain or discomfort at the surgical site
• Need for additional surgeries

Benefits

• Improved spinal stability
• Reduced pain
• Prevention of further spinal damage
• Enhanced ability to undergo additional spinal treatments or surgeries

Recovery

• Postoperative care includes pain management and wound care.
• Patients may need to wear a brace during the initial healing period.
• Physical therapy is often recommended to aid recovery.
• Recovery time varies but typically ranges from several weeks to a few months.
• Follow-up appointments are necessary to monitor healing and progress.

Alternatives

• Non-surgical management (e.g., bracing, physical therapy)
• Other surgical techniques such as spinal fusion with rods and screws
• Conservative treatments (medications, lifestyle modifications)

Pros and cons of alternatives should be discussed with the healthcare provider to determine the best course of action based on individual patient circumstances.

Patient Experience

Patients can expect to feel soreness and discomfort in the surgery area immediately after the procedure, which is managed with pain medications. Early mobilization may be encouraged to prevent complications, and adherence to postoperative instructions is crucial for optimal recovery.