Orthopedic surgery or orthopedics is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors, and congenital disorders.
Spondylosis is the degeneration of the vertebral column from any cause. In the more narrow sense it refers to spinal osteoarthritis, the age-related degeneration of the spinal column, which is the most common cause of spondylosis. The degenerative process in osteoarthritis chiefly affects the vertebral bodies, the neural foramina and the facet joints. If severe, it may cause pressure on the spinal cord or nerve roots with subsequent sensory or motor disturbances, such as pain, paresthesia, imbalance, and muscle weakness in the limbs.
Degenerative disc disease (DDD) is a medical condition typically brought on by the normal aging process in which there are anatomic changes and possibly a loss of function of one or more intervertebral discs of the spine. DDD can take place with or without symptoms, but is typically identified once symptoms arise. The root cause is thought to be loss of soluble proteins within the fluid contained in the disc with resultant reduction of the oncotic pressure, which in turn causes loss of fluid volume. Normal downward forces cause the affected disc to lose height, and the distance between vertebrae is reduced. The anulus fibrosus, the tough outer layers of a disc, also weakens. This loss of height causes laxity of the longitudinal ligaments, which may allow anterior, posterior, or lateral shifting of the vertebral bodies, causing facet joint malalignment and arthritis; scoliosis; cervical hyperlordosis; thoracic hyperkyphosis; lumbar hyperlordosis; narrowing of the space available for the spinal tract within the vertebra ; or narrowing of the space through which a spinal nerve exits with resultant inflammation and impingement of a spinal nerve, causing a radiculopathy.
Bone morphogenetic proteins (BMPs) are a group of growth factors also known as cytokines and as metabologens. Professor Marshall Urist and Professor Hari Reddi discovered their ability to induce the formation of bone and cartilage, BMPs are now considered to constitute a group of pivotal morphogenetic signals, orchestrating tissue architecture throughout the body. The important functioning of BMP signals in physiology is emphasized by the multitude of roles for dysregulated BMP signalling in pathological processes. Cancerous disease often involves misregulation of the BMP signalling system. Absence of BMP signalling is, for instance, an important factor in the progression of colon cancer, and conversely, overactivation of BMP signalling following reflux-induced esophagitis provokes Barrett's esophagus and is thus instrumental in the development of esophageal adenocarcinoma.
Klippel–Feil syndrome (KFS), also known as cervical vertebral fusion syndrome, is a rare congenital condition characterized by the abnormal fusion of any two of the seven bones in the neck. It can result in a limited ability to move the neck and shortness of the neck, resulting in the appearance of a low hairline. Most people only have one or two of those symptoms so it may not be noticeable without medical imaging.
Spinal fusion, also called spondylodesis or spondylosyndesis, is a surgery performed by orthopaedic surgeons or neurosurgeons that joins two or more vertebrae. This procedure can be performed at any level in the spine and prevents any movement between the fused vertebrae. There are many types of spinal fusion and each technique involves using bone grafting—either from the patient (autograft), donor (allograft), or artificial bone substitutes—to help the bones heal together. Additional hardware is often used to hold the bones in place while the graft fuses the two vertebrae together. The placement of hardware can be guided by fluoroscopy, navigation systems, or robotics.
Failed back syndrome or post-laminectomy syndrome is a condition characterized by chronic pain following back surgeries. Many factors can contribute to the onset or development of FBS, including residual or recurrent spinal disc herniation, persistent post-operative pressure on a spinal nerve, altered joint mobility, joint hypermobility with instability, scar tissue (fibrosis), depression, anxiety, sleeplessness, spinal muscular deconditioning and even Cutibacterium acnes infection. An individual may be predisposed to the development of FBS due to systemic disorders such as diabetes, autoimmune disease and peripheral blood vessels (vascular) disease.
Anterior cervical discectomy and fusion (ACDF) is a surgical procedure to treat nerve root or spinal cord compression by decompressing the spinal cord and nerve roots of the cervical spine with a discectomy, followed by inter-vertebral fusion to stabilize the corresponding vertebrae. This procedure is used when other non-surgical treatments have failed.
Manipulation under anesthesia (MUA) or fibrosis release procedures is a multidisciplinary, chronic pain-related manual therapy modality which is used for the purpose of improving articular and soft tissue movement. This is accomplished by way of a combination of controlled joint mobilization/manipulation and myofascial release techniques. MUA is used by osteopathic/orthopedic physicians, chiropractors and specially trained physicians. It aims to break up adhesions on or around spinal joints or extremity joints to which a restricted range of motion can be painful and limit function. Failed attempts at other standard conservative treatment methods, over a sufficient time-frame, is one of the principal patient qualifiers.
Jack Elliot Zigler is a Board Certified orthopedic surgeon specializing in spine surgery at the Texas Back Institute in Plano, Texas. He is best known for being the first surgeon to perform a ProDisc artificial disc replacement surgery in the United States, on October 3, 2001.
An artificial facet replacement is a joint prosthesis intended to replace the natural facets and other posterior elements of the spine, restoring normal motion while providing stabilization of spinal segments. It is typically used as an adjunct to laminectomy, laminotomy, neural decompression, and facetectomy, in lieu of standard lumbar fusion. The prosthesis is indicated for back and leg pain caused by central or lateral spinal stenosis, degenerative disease of the facets with instability, and grade 1 degenerative spondylolisthesis with objective evidence of neurological impairment.
Hip resurfacing has been developed as a surgical alternative to total hip replacement (THR). The procedure consists of placing a cap, which is hollow and shaped like a mushroom, over the head of the femur while a matching metal cup is placed in the acetabulum, replacing the articulating surfaces of the person's hip joint and removing very little bone compared to a THR. When the person moves the hip, the movement of the joint induces synovial fluid to flow between the hard metal bearing surfaces lubricating them when the components are placed in the correct position. The surgeon's level of experience with hip resurfacing is most important; therefore, the selection of the right surgeon is crucial for a successful outcome. Health-related quality of life measures are markedly improved and the person's satisfaction is favorable after hip resurfacing arthroplasty.
Pulsed electromagnetic field therapy, also known as low field magnetic stimulation (LFMS) is the use of electromagnetic fields in an attempt to heal non-union fractures and depression. By 2007 the FDA had cleared several such stimulation devices.
An interbody fusion cage is a prosthesis used in spinal fusion procedures to maintain foraminal height and decompression. They are cylindrical or square-shaped devices, and usually threaded. There are several varieties: the Harms cage, Ray cage, Pyramesh cage, InterFix cage, and lordotic LT cage, all of which are made from titanium; the Brantigan cage, made from carbon fibre; and the Cortical Bone Dowel, which is cut from allograft femur. The cages can be packed with autologous bone material in order to promote arthrodesis. Such implants are inserted when the space between the spinal discs is distracted, such that the implant, when threaded, is compressed like a screw. Unthreaded implants, such as the Harms and Pyramesh cages have teeth along both surfaces that bite into the end plates.
Metallosis is the medical condition involving deposition and build-up of metal debris in the soft tissues of the body.
Spinal stenosis is an abnormal narrowing of the spinal canal or neural foramen that results in pressure on the spinal cord or nerve roots. Symptoms may include pain, numbness, or weakness in the arms or legs. Symptoms are typically gradual in onset and improve with leaning forward. Severe symptoms may include loss of bladder control, loss of bowel control, or sexual dysfunction.
Richard N.W. Wohns is a neurosurgeon who is the founder and president of NeoSpine, LLC. He has been listed one of the 50 Spine Surgeons and Specialists to Know by Becker's ASC Review. He currently practices and teaches medicine in the Puget Sound Region of Washington, United States.
Due to the many regulations in the industry, the design of medical devices presents significant challenges from both engineering and legal perspectives.
Thomas Schuler, M.D., F.A.C.S is an American spinal surgeon, researcher and educator in the treatment of neck and low back conditions. He was an early adopter of stem cell therapy, biologics, robotics, laser and hybrid surgery and augmented reality for spinal surgery. Schuler specializes in cervical and lumbar disc replacement procedures, minimally invasive spine surgery and robotic spine surgery. He performed the first hybrid multi-level cervical artificial disc replacement with spinal fusion in the country. He founded a practice that has performed some of the first robotic and augmented reality spinal surgeries in the world. In 2002 he created and currently serves as President of the National Spine Health Foundation, a national non-profit focused on education, research and patient advocacy of neck and back health.
The total posterior spine or TOPS system is an FDA-approved mechanical implant that serves as an alternative to lumbar interbody fusion surgery after decompression. It was developed by Impliant and commercially launched by Premia Spine.
