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Spinal neurosurgery is a branch of neurosurgery. It is a medicine that diagnoses and treats the central, peripheral, and autonomic nervous systems and their supporting structures.

Spinal neurosurgery

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Spinal neurosurgery is a branch of neurosurgery. It is a medicine that diagnoses and treats the central, peripheral, and autonomic nervous systems and their supporting structures.

Chinese name

Spinal neurosurgery

Classification

neurosurgery

Spinal neurosurgery is a medicine that diagnoses and treats the spinal cord and its supporting structures, and is an important branch of neurosurgery.

Mainly include: 1. Spinal degenerative diseases, such as cervical spondylosis, lumbar disc herniation, etc. These most common diseases account for more than 80% of various spinal surgeries; 2. Spinal and spinal trauma; 3. Spinal canal tumors; 4. Spinal deformities .

Spinal neurosurgery began in the early 20th century. In 1905, Cushing reported the first case of intramedullary tumor resection; in 1909, Openheim reported a case of L5 / S1 discectomy. Since then, various spinal and spinal cord surgical treatments and various approaches have been reported, and spinal neurosurgery has gradually been carried out. In the early days, due to the backwardness of imaging technology, surgical instruments, lighting equipment, and insufficient understanding of spinal stability by neurosurgeons, the accuracy of the diagnosis of spinal and spinal cord disease in clinical work was poor, and the surgical treatment was not effective. Spinal cord injuries and spinal surgeries often occurred after surgery. Complications such as deformity. Hounsfield invented CT in 1973, which was the first major leap in the history of spinal neurosurgery. In 1977, the application of MRI in the field of neurosurgery became the second leap in spinal neurosurgery. It can be said that the emergence of CT and MRI has brought a landmark development to spinal neurosurgery. The "three-column theory of the spine" proposed by Denis in 1983 became the mechanical basis for guiding spinal neurosurgery. Based on this theory, with the development and combination of engineering and materials science, and the innovation of surgical instruments, new materials, new technologies and new methods are constantly emerging and applied to the clinic. Spinal neurosurgery has achieved rapid development, especially recently. The development of spinal neurosurgery for more than 10 years can be described as fast-changing, and the speed is amazing.

The definition of spinal neurosurgery is derived from the American Association of Neurosurgeons' definition of neurosurgery. Its content is: medicine for the diagnosis and treatment of the central, peripheral and autonomic nervous systems and their supporting structures.

The Chinese Society of Neurosurgery also clearly pointed out that the diagnosis and treatment of spinal and spinal cord diseases belong to the professional category of neurosurgery. This laid the foundation for spinal surgery performed by neurosurgeons. As we all know, the spine and spinal cord are inseparable and interdependent, just like the relationship between the skull and the brain. Both the brain and spinal cord belong to the central nervous system. The skull, as the supporting structure of the brain, belongs to the diagnosis and treatment of neurosurgery. The spine, as the supporting structure of the spinal cord, should also belong to an important branch of neurosurgery. And based on neurosurgeons are more familiar with neuroanatomy and neurophysiology, and pay more attention to the protection of neural tissue. In particular, the widespread use of micromanipulation techniques in neurosurgery has made neurosurgeons' operations more precise and safer. Therefore, spinal and spinal cord surgery in Europe and the United States is mostly undertaken by neurosurgeons.

For a long time, with regard to spinal and spinal cord diseases, in many people's concepts, epidural lesions belong to the category of orthopaedic treatment, and intradural lesions belong to neurosurgery. In fact, spinal neurosurgery belongs to a typical interdisciplinary discipline, which includes both the spine bone structure and the spinal cord central and spinal nerve structures. Due to the late start of neurosurgery in China, in the past, the treatment of spinal neurosurgery diseases was basically undertaken by orthopaedic surgeons. Although neurosurgeon predecessors began spinal surgery at the beginning of the founding of the People's Republic of China, the proportion of them was very small, and surgery Mainly focused on the resection of tumors in the spinal canal. The main reason is that neurosurgeons pay more attention to the protection of the spinal cord and nerves, less consideration of the stability of the spine, or little understanding of the spine biomechanical structure and internal fixation technology. In the past, it was simple to bite the lamina, or even lamina of multiple segments. Many years later, many of these patients had spinal deformities. So ignoring spinal stability has become the biggest problem for neurosurgeons in the past. Neurosurgeons began to reflect, began to understand spinal and spinal cord diseases from a comprehensive and holistic perspective, and began to learn new technologies and new theories of spinal fixation. At present, some major domestic hospitals have established spinal neurosurgery treatment centers. Combining neuromicrosurgery technology and internal fixation technology, they have achieved excellent results in the surgical treatment of spinal and spinal cord diseases.

In European and American countries, spinal diseases mostly belong to neurosurgery, and neurosurgeons are dedicated to the field of spinal neurosurgery. The volume of spinal and spinal cord diseases in many large neurosurgery centers, accounting for more than 40-60% of the total surgery. There are many neurosurgeons in the history of surgery. Cushing, Cloward, Goel, Bryan, Laheri and other neurosurgeons have made great contributions to the development of spinal fixation materials. In 2000, the journal of the American Association of Neurosurgeons, J Neurosurgery, officially published the spine volume J Neurosurgery: Spine, thereby making spinal neurosurgery another important branch of functional neurosurgery and interventional neurosurgery.

Spinal neurosurgery can be summarized in two aspects, namely decompression and fixation. Reports have pointed out that incomplete decompression is the main reason for the poor efficacy of cervical spondylosis surgery. The serious complications and even death caused by high neck surgery are mostly related to surgical operations, and neurosurgeons can pass this aspect. Micromanipulation technology makes full use of its specialties.
Neurosurgery and orthopedics have their own expertise in spine surgery. Neurosurgeons are good at protecting the spinal cord and nerves, and orthopedics are better at stabilizing the spine. Spinal neurosurgery must combine the two perfectly, and analyze and treat from a holistic perspective. Spinal neurosurgery must have formal professional training, and neurosurgeons transition from spinal microsurgery to spinal disc surgery, and orthopedic surgeons from spinal disc surgery to spinal microsurgery, the difficulty is obviously different. . Neurosurgeons have microsurgical techniques and different training backgrounds. They have a deeper understanding of the anatomy and physiology of spinal nerves. Neurosurgeons have unique advantages in dealing with spinal cord and nerve decompression. Spinal stability seems to be a weak point of neurosurgery. In fact, not only can neurosurgeons maintain and restore spinal stability through internal fixation equipment, but also can reduce the scope of spinal canal opening and reduce the spinal trauma through microsurgical techniques. To minimize the impact on spinal stability. It can be said that although neurosurgeons also need training in spinal fixation, it is not difficult compared to microscopy, and the transition from orthopedics to spinal neurosurgery requires special training.

Don't be underscored, spinal neurosurgery is a cross-disciplinary discipline, and neurosurgery and orthopedics have their own strengths. The two disciplines should not be isolated, competitive or even antagonistic. Instead, they should learn from each other, complement each other, promote each other, and develop harmoniously. For neurosurgeons, spinal neurosurgery should be carried out in a positive manner, but spinal neurosurgery must be open-minded to learn spinal fixation techniques from orthopedists, and must undergo strict spinal fixation techniques training. Do not be arrogant, Quick success. At present, the scale of spinal neurosurgery in China still lags far behind the developed countries in Europe and the United States. Our neurosurgeons should follow the idea of "all for the patient", learn from each other with orthopedic surgeons, implement the scientific minimally invasive concept, and give full play to neurosurgery Technical advantages, actively promote the development of spinal neurosurgery in China, and ultimately bring more help to the majority of patients.