Name of the Procedure

Insertion of Intervertebral Biomechanical Device(s): Commonly referred to as the insertion of synthetic cages, mesh, or methylmethacrylate to the intervertebral disc space or vertebral body defect without interbody arthrodesis.

Summary

This procedure involves placing a biomechanical device, such as a synthetic cage or mesh, into the intervertebral disc space or a vertebral body defect. It does not include fusion of the vertebrae (interbody arthrodesis) and addresses structural issues in the spine.

Purpose

The procedure is performed to stabilize and support the spine in cases where there is a defect or degeneration in the intervertebral disc or vertebral body. This can help to alleviate pain, restore function, and prevent further spinal deformity.

Indications

• Degenerative disc disease.
• Traumatic vertebral fractures.
• Vertebral body tumors.
• Spinal deformities or instabilities.
• Persistent back pain not responding to conservative treatments.

Preparation

• Patients may need to fast for a few hours before the procedure.
• Adjustments to current medications, particularly blood thinners.
• Preoperative imaging tests such as MRI or CT scans to assess the affected area.
• Pre-anesthetic evaluation to ensure the patient is fit for the procedure.

Procedure Description

1. Anesthesia: General or spinal anesthesia is administered.
2. Incision: A small incision is made at the site of the defect.
3. Accessing the Spine: Muscles and tissues are carefully moved aside to reach the spinal column.
4. Defect Preparation: The defect or intervertebral space is prepared for the device.
5. Device Insertion: The synthetic cage, mesh, or methylmethacrylate device is inserted into the defect.
6. Closure: The incision is closed with sutures or staples, and a sterile dressing is applied.

Duration

The procedure typically takes 1 to 3 hours, depending on the complexity of the case and the number of defects being addressed.

Setting

The procedure is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic or neurosurgeon.
• Anesthesiologist.
• Surgical nurses.
• Operating room technicians.

Risks and Complications

• Infection at the surgical site.
• Bleeding or hematoma.
• Nerve damage leading to numbness, weakness, or pain.
• Device failure or displacement.
• Allergic reactions to materials used.
• Chronic pain or failure to alleviate symptoms.

Benefits

• Stabilization of the spine.
• Reduction in pain and improved mobility.
• Prevention of further spinal damage or deformity.

Recovery

• Patients may need to stay in the hospital for a few days post-procedure.
• Pain management with prescribed medications.
• Gradual resumption of activities; physical therapy may be recommended.
• Follow-up appointments for monitoring recovery and device placement.
• Full recovery may take several weeks to months, depending on individual progress.

Alternatives

• Conservative treatments like physical therapy, medication, and spinal injections.
• Spinal fusion (interbody arthrodesis) if stability is a major concern.
• Other surgical options depending on the specific spinal condition.

Patient Experience

• Patients can expect some discomfort and pain managed with medications.
• They might experience limited mobility and will need assistance initially.
• Gradual improvement in pain and function with adherence to recovery protocols.