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Spine Services

The Spine Service specializes in precision-oriented diagnosis for individuals with various spinal conditions. We are proud to be recognised as the leading centre for minimally invasive spine surgery in South East Asia and have over the years established ourselves as a major referral centre for spinal deformity surgery.

Conditions:

Conditions that our specialists treat include the following:
  • Spinal Stenosis
  • Cervical Arthritis (Spondylosis)
  • Fractures of the spine 
  • Kyphosis
  • Spondylolysis
  • Spondylolisthesis
  • Degenerative Disc Disease
  • Scoliosis
  • Ankylosing Spondylitis
  • Radiculopathy
They are explained in greater detail below:

Spinal Stenosis

Spinal stenosis is a narrowing of the spaces within your spine, which can put pressure on the nerves that travel through the spine. Spinal stenosis occurs most often in the lumbar spine (lower back) and the cervical spine (neck). It can be caused by age-related degeneration of the spine or traumatic injury to the spine. In rarer instances, stenosis can be due to tumor, infection, or congenital anomaly (occurring at birth).

Cervical Arthritis (Spondylosis)

The condition is also known as cervical osteoarthritis or neck arthritis. It is a common, age-related condition that affects the joints and discs in your neck. It develops from wear and tear of the cartilage and bones found in your cervical spine, which is in your neck. While it’s largely due to age, it can be caused by other factors as well.

Fractures of the spine

The spinal column consists of a series of vertebrae (made of bone) attached to each other by discs (made of soft collagen) and stabilized by a complex arrangement of ligaments, muscles, and joints. In contrast to the lumbar spine (lower back portion of the spine), the cervical spine (neck portion of the spine) houses nerves that comprise the spinal cord.

If the spinal column is subject to sufficient trauma, the bony elements of the spinal column can fracture (break). The stability of the spine following the fracture largely depends upon on the severity of the fracture and the integrity of the stabilizing structures. Unstable spines can be associated with an increased risk of the neurologic (nerve) damage. An unstable cervical spine can be associated with an increased risk of the spinal cord damage and can lead to weakness and dysfunction of the arms and legs.

Kyphosis

Kyphosis is a curvature in the sagittal plane (front to back plane) of the body with the apex of the curve directed posteriorly. It exists as part of the normal spine alignment and may measure up to forty-five degrees. Studies looking at chest radiographs in normal individuals have shown that this number can increase with age.
The three main types of abnormal kyphosis are postural kyphosis, Scheuermann’s kyphosis and congenital kyphosis.
  • Postural Kyphosis
    Postural kyphosis is the most common type of kyphosis. This is more common in girls than in boys and is typically first noticed during adolescence. It is caused by poor posture and a weakening of the muscles and ligaments in the back (paraspinous muscles). These patients can have symptoms of pain and muscle fatigue.
  • Scheuermann’s Kyphosis
    The condition, also known as Scheuermann’s Disease, is first noticed during adolescence. It is a deformity in the thoracic or thoracolumbar spine in which patients have an increased kyphosis along with backache and localized changes in the vertebral bodies.
  • Congenital Kyphosis
    There are 2 basic types of congenital kyphosis, failure of formation and failure of segmentation. The failure of formation of a portion of one or more vertebral bodies, which most often occur in the thoracolumbar spine, results in a kyphosis that usually worsens with growth. The deformity is usually visible at birth as a lump or bump on the infant's spine.
    The failure of segmentation deformity occurs as two or more vertebrae fail to separate and form   normal discs and rectangular bones. This type of congenital kyphosis is often more likely to be diagnosed later, when the child is able to walk.

Spondylolysis

Spondylolysis is a spinal stress fracture of a bone structure called the pars interarticularis. The fracture usually occurs not as a single traumatic event, but as the result of cumulative microtrauma from repetitive activity. Spondylolysis usually occurs in childhood and may not become symptomatic until many years later.

Spondylolisthesis

Spondylolisthesis is a condition that occurs when spondylolysis is left untreated. The vertebra is weakened so much that it is unable to maintain its proper position in the spine. Another form, called degenerative spondylolisthesis, is caused by the degenerative deterioration of the facet joints and discs. Symptoms of both may include localized low back pain and/or radiating leg pain in the case of spondylolisthesis with nerve compression

Degenerative Disc Disease

Degenerative disc disease is the progressive deterioration of spinal discs and arthritic changes in facet joints due to wear and tear with aging. The overgrowth of bone spurs can also produce narrowing of the spinal canal, resulting in spinal stenosis, causing pain, numbness and weakness in the legs due to compression of the neural elements.

Scoliosis

Scoliosis is an abnormal curvature of the spine. The majority of cases, particularly those occurring in adolescents, tend to have a genetic basis. However, certain neuromuscular disorders, such as muscular dystrophy, can cause scoliosis. Additionally, asymmetric spinal disc degeneration can cause the spine to curve, resulting in a form or scoliosis that primarily affects adults.

Ankylosing Spondylitis

Ankylosing spondylitis is a chronic inflammatory disorder of unknown origin that primarily affects the spine, sternum, and large joints in the body. The most distinctive feature of this condition is a significant or complete loss of flexibility in the spine. People with this disorder experience lower back pain, morning stiffness, and limited motion.

Radiculopathy

Radiculopathy occurs when a spinal nerve root is pinched or pressed, inflamed or injured. This can cause pain along a nerve pathway, most commonly pain that runs from the neck or back through the affected arm or leg and possibly into the hand or foot.

There are 3 types of radiculopathy:
  • Cervical radiculopathy
    Cervical radiculopathy is pressure on one of the nerve roots in your neck. It can cause weakness, burning or tingling, or loss of feeling in your shoulder, arm, hand, or finger.
  • Thoracic radiculopathy
    Thoracic radiculopathy happens when there’s a pinched nerve in the upper back portion of your spine. This causes pain in your chest and torso. It’s uncommon and can be mistaken for shingles.
  • Lumbar radiculopathy
    Lumbar radiculopathy is pressure on one of the nerve roots in your lower back. It can cause hip pain and sciatica, or shooting pain in your leg. Incontinence, sexual dysfunction, or paralysis can also occur in severe cases.

Surgical Techniques

Listed below are some of the surgical procedures performed by our surgeons:

Discectomy for removal of prolapsed (‘slipped’) discs

Discectomy is surgery to remove lumbar (lower back) herniated disc material that is pressing on a nerve root or the spinal cord. This is usually done through minimally invasive discectomy, also known as microdiscectomy. In this procedure, surgeons use a laparoscopic microscope to view the discs and nerves. With a better view of the area, smaller incisions need to be made and less damage is caused to surrounding tissues. Recovery time is shorter as well, with most patients going home the same day of treatment. They are able to return to work within two to four weeks, if their job does not involve any strenuous activity.

Patient Outcomes
Good results are achieved in 80 to 90% of patients treated with lumbar discectomy. People with moderate to severe pain who had surgery noticed a greater difference than those who did not have surgery. 
Minimally invasive discectomy techniques have been shown to be comparable in outcomes with open discectomy. The benefits of minimally invasive approaches include shorter operative time, less blood loss and muscle trauma, as well as a faster recovery period.  The success rate for microdiscectomy spine surgery is generally high, with one extensive medical study showing good or excellent results overall for 84% of people who have the procedure. Your surgeon will advise you if you are a suitable candidate for this type of minimally invasive surgery.

Spinal fusion

In some patients, back pain is due to instability of the spinal column which can be due to degenerative changes in the spine. In such cases, your specialist may advise that the unstable portions of the spine be joined together so as to limit abnormal movements and thus reduce pain.  Such procedures are currently normally performed with special rods and screws to increase the success rate of the procedure.

Spinal Instrumentation

It utilizes surgical procedures to implant titanium, titanium-alloy, stainless steel, or non-metallic devices into the spine. Instrumentation provides a permanent solution to spinal instability. Medical implants are specially designed and come in many shapes and sizes. Typically these include rods, hooks, braided cable, plates, screws, and interbody cages. Cages are simply structures that support bones (either between bones or in place of them) while new bone growth occurs through and around them.

Instrumentation maintains spinal stability while facilitating the process of fusion. These procedures are used to restore stability to the spine, correct deformity (such as scoliosis) and bridge space created by the removal of a spinal element (eg, intervertebral disc). They join and solidify the level where a spinal element has been damaged or removed.

Vertebroplasty and kyphoplasty

Vertebroplasty is an outpatient procedure for stabilizing compression fractures in the spine. Bone cement is injected into back bones (vertebrae) that have cracked or broken, often because of osteoporosis. The cement hardens, stabilizing the fractures and supporting your spine.

Kyphoplasty is similar to vertebroplasty, but uses special balloons to create spaces in the spine that are then filled with bone cement. Kyphoplasty can correct spinal deformity and restore lost height.

Patient Outcomes
In older patients who are suffering from persistently painful osteoporotic fractures of the lower back vertebrae, these relatively simple procedures have proven to be useful in relieving pain and improving mobility. A number of reviews have shown kyphoplasty to be efficacious, providing rapid pain relief, reducing need for pain medication, improving functional ability and enhancing health-related quality of life.

Posterior Cervical Laminotomy

Decompression neck surgery to relieve a compressed spinal nerve
Cervical laminotomies are performed to relieve pressure on a compressed spinal nerve in the neck. Removal of bone spurs or disc herniations usually relieves the associated neck and arm pain. Whereas laminectomies remove the entire lamina, a laminotomy is done when only a portion of the lamina needs to be excised in order to remove material that is compressing nerve roots.

Instrumented Cervical Laminectomy, Fusion

Decompression neck surgery for patients with spinal stenosis
A section of the spinal canal is removed in patients with spinal stenosis to release pressure on the spinal cord. Instrumentation is then used to stabilize the vertebrae.

Cervical Laminoplasty

Decompression neck surgery to remove pressure on the spinal cord and nerves caused by spinal stenosis
A cervical laminoplasty is performed to remove pressure on the spinal cord and nerves caused by spinal stenosis, a condition in which there is a narrowing of the spinal canal. The laminoplasty procedure involves making a hinge on one side of the lamina to create more space, relieving the pressure on the spinal cord.

Anterior Thoracic Vertebral Body Replacement

Back surgery for a fractured vertebra caused by trauma or tumor growth
An anterior thoracic vertebral body replacement approaches the spine from the front, removes and replaces a damaged vertebra as well as stabilizes the spine. The procedure can remove painful pressure on the spinal cord and nerves that has resulted from trauma in which a vertebra is severely fractured, or pressure caused when a tumor has spread to the front of the spine and fractured a vertebra.

Instrumented Anterior Cervical Discectomy, Fusion (ACDF)

Decompression neck surgery to remove pressure on nerves from disc herniations
A section of the ruptured disc is removed in patients with spinal stenosis to remove pressure on nerves from disc herniations. A bone graft is usually inserted with instrumentation to keep the disc space at a normal height and fuse the vertebrae above and below the removed disc.

Lumbar Vertebral Body Replacement

Surgery to replace damaged or fractured vertebrae in the lower back
Spine fractures involving the vertebral body in the lumbar spine (lower back) can cause pressure on the spinal nerves, resulting in pain. Severe fractures are unstable and often require surgery to remove and replace the damaged vertebra and stabilize the spine. A lumbar vertebral body replacement involves replacing the affected area with a small metal cage filled with bone graft material, which is then screwed into the adjacent healthy vertebrae.

Lumbar Interbody Fusion

Lumbar interbody fusion is a surgical treatment to stabilize the motion of vertebrae and to relieve nerve and back pain for people with lumbar spine problems. 

A variety of techniques exist for fusing lumbar spine vertebrae to help alleviate back pain, including posterior, transforaminal, anterior, and lateral lumbar interbody fusion (PLIF, TLIF, ALIF, and LLIF, respectively). More details can be found below. 

  • Posterior Lumbar Interbody Fusion (PLIF)
    A posterior lumbar interbody fusion (PLIF) is performed to remove a disc that is the source of back or leg pain and fuse spinal vertebrae with bone grafts. It is called a posterior procedure because the spine is approached through an incision on the back. Instrumentation is used to provide space for placing the grafts and to help stabilize the spine.

  • Transforaminal Lumbar Interbody Fusion (TLIF)
    As in the posterior lumbar interbody fusion (PLIF) procedure, a bone graft is used to fuse the spinal vertebrae after the disc is removed. However, the TLIF procedure places a single bone graft between the vertebrae from the side, rather than two bone grafts from the rear, as in the PLIF procedure. Inserting the graft from the side where the facet joint has been removed is an effort to avoid moving or damaging nerve roots during the procedure.

  • Minimally Invasive PLIF & TLIF
    In patients with spinal instability, they may wish to consider minimally invasive surgery whereby instrumentation is used to provide space and help stabilize the spine during the bone graft fusion. Smaller incisions are being made, compared to traditional open spinal surgeries. Thus, decreasing damage to the lower back muscles.
    Patient Outcomes
    Patients who are good candidates for a TLIF often experience dramatic improvement in back and leg pain after recovering from surgery. Studies indicate that the patient's pain is improved 60% to 70% after TLIF spinal fusion surgery and approximately 80% of patients undergoing TLIF spinal fusion surgery are satisfied with the surgical result.

  • Anterior Lumbar Interbody Fusion (ALIF)
    This surgery is performed to remove a large portion of a degenerated disc that is frequently the source of back or leg pain. This procedure makes space between the vertebral bodies, relieving pressure and creating more room for spinal nerves to exit. It is called an anterior procedure because the spine is approached from the front. Unlike posterior approaches (from the back), the anterior approach avoids damage to the lower back muscles. The removed disc portion is replaced with implanted bone grafting materials and adjacent vertebral bodies fuse to provide support.

  • Lateral Lumbar Interbody Fusion (LLIF)
    This procedure, also known as lateral access spine surgery, is a minimally invasive surgery that accesses the spine from incisions on the side of the body. This procedure avoids separating the lower back muscles, cutting bone, or moving aside blood vessels as required for other minimally invasive spine fusion procedures (PLIF, TLIF, ALIF). Lateral access spine surgery can treat a variety of conditions including herniations, asymmetric disc degeneration (degenerative scoliosis), nerve impingement, certain tumors as well as instability and pain resulting from disc degeneration.

Posterior Lumbar Laminectomy

A posterior lumbar laminectomy, which is also called a decompression, is done to treat pain caused by degenerative conditions in the lower back. Disc degeneration, bone spurs, and other conditions can cause narrowing and pressure on the spinal nerves (radiculopathy) exiting the spine. A laminectomy procedure removes part of the vertebral lamina to reduce the pressure.

Thoracic Laminectomy with Instrumentation, Fusion 

Decompression back surgery for relief of spinal stenosis and tumor removal
A narrowing of the spinal canal can cause painful pressure on the spinal cord or nerves. Sometimes the source of this narrowing is a tumor that has spread to the thoracic region of the spine and is pushing on the spinal cord.
A thoracic laminectomy removes the lamina from vertebral bodies, providing access to remove the tumor and eliminate pressure on the spinal cord. After removing bone, instrumentation can be added to stabilize the vertebrae.

Minimally Invasive Lumbar Discectomy/Percutaneous Disc Removal (PDR)

Lower back surgery involving percutaneous removal of a herniated disc, also known as a discectomy and partial discectomy
  • Minimally Invasive Lumbar Discectomy
    A herniated lumbar disc can push on spinal nerves and cause severe, shooting leg pain, numbness and/or weakness. A percutaneous disc removal (PDR) can remove a portion of the herniated disc that is compressing spinal nerves through a small incision in the skin. This minimally invasive approach uses a much smaller incision than traditional open spinal surgeries and avoids damage to the low back muscles.
  • Minimally Invasive Partial Lumbar Discectomy
    In some cases, removing part of the herniated disc in a partial discectomy procedure can also prevent the disc from irritating the nerve.

Derotation of the Thoracic Spine with Instrumentation

Back surgery using rods, screws and hooks to rotate and straighten the spine
Correcting scoliosis usually involves placing multiple screws or hooks along the length of the curve and using instrumentation to decrease the curvature. Screws are placed in the drilled holes and metal rods are positioned between the screws and fastened in place. The rods are then rotated in a fashion that straightens the spine. The rod and screw instrumentation prevents the vertebrae from moving while the bone graft fusion takes place. Bone grafts or bone graft substitutes may be added to fuse the vertebrae in the straighter, less curved spine configuration

Patient Outcomes

Decompressive laminectomy is successful in relieving leg pain in 70% of patients, allowing significant improvement in function (ability to perform normal daily activities) and markedly reduced level of pain and discomfort.
Decompressive laminotomy is successful in relieving back pain (72%) and leg pain (86%) and in improving walking ability (88%). Endoscopic laminotomy results in less blood loss, shorter hospital stays and requires less postoperative pain medication than an open laminotomy. 

Over the past decade, significant advances have occurred in surgery to correct scoliosis and spinal deformity. Improvements in spinal implants and biologics that promote bone fusion have led to better outcomes and easier recovery for adolescents with idiopathic scoliosis and adults with degenerative scoliosis. Teenagers who undergo spine fusion for scoliosis using the newest surgical techniques can expect to be doing well 10 years after surgery.