Goodman Campbell Brain and Spine - Indianapolis, Indiana

TRAUMA

Procedures

Anterior Fusion: In an anterior spinal fusion the intervertebral disc is removed and the vertebrae fused together via a transverse or vertical incision over the lower abdomen. The majority of the symptomatic intervertebral disc or discs are removed and replaced with bone. This bone is obtained from the front of the pelvis, usually through the same skin incision. It may be taken as a large piece, but more commonly small pieces of bone are obtained which are then packed into a hollow implant or cage. The block of bone or the cage is then inserted between the vertebrae.

Closed Reduction: Reduction of a displaced part (as a fractured bone) by manipulation without incision.

Combined Anterior & Posterior Fusion: A combined anterior and posterior fusion is both an anterior and Postero-lateral fusion at the same time, or under the same anesthetic. The risks for both procedures are the same as if either procedure was done in isolation. The advantage is that the chance of achieving a fusion and of eliminating the source of symptoms is improved.

Fusion requires a process of healing which is similar to the way broken bones heal, and will take between three and six months to complete.

Technically we are looking to achieve a solid fusion. The chance of achieving technical success, a solid fusion, with either an anterior or posterior fusion alone is in the order of 70 - 75%. With a combined anterior and posterior fusion the fusion rate increases to 90 - 95%. This difference is significant.

Clinically we are looking to relieve symptoms of back pain, and there is no good correlation between achieving a solid fusion and the relief of symptoms.

For either an anterior or posterior fusion in isolation, the clinical success rate for a single or two- level fusion is in the order of 70%. With a combined fusion this increases to around 75%. This difference is not statistically significant but the trend has resulted in more and more patients being treated with combined anterior and posterior surgery. Where three levels are involved in the degenerative process and contribute to symptoms, the success rate decreases considerably and may be no better than 40 - 50%.

Craniofacial Reconstruction: Surgical treatment to repair deformities of the head and face.

Cranioplasty: Cranioplasty is a surgical repair of a defect or deformity of the skull.

Replace a bone flap - surgical reinsertion of a piece of bone removed during a craniotomy
Place HTMP cranial flap with spilt cranial grafts
Place ICP monitor - a small tube placed into or just on top of the brain through a small hole in the skull. This will measure the pressure inside the brain (intracranial pressure).

Craniotomy: A surgical procedure in which part of the skull, called a skull flap, is removed in order to access the brain.

Debride Brain: To remove dead tissue, etc. surgically from a wound.

Decompression: A surgical procedure that is performed to alleviate pain caused by pinched nerves (neural impingement). In this type of back surgery, a small portion of the bone over the nerve root and/or disc material from under the nerve root is removed to give the nerve root more space and provide a better healing environment. Several conditions may cause neural impingement, including spinal stenosis, a disc herniation, spondylolisthesis, or a rare spinal tumor.

There are two common types of spine surgery decompression procedures:

Microdiscectomy (or microdecompression)
Laminectomy (or open decompression)

Decompression for Increased Intracranial Pressure: Craniotomy performed to relieve pressure on the brain by drilling burr holes through the skull to remove a bone flap, remove a clot, or place a shunt to drain cerebrospinal fluid (CSF).

Elevate Depressed Fracture: A depressed skull fracture is a break in a cranial bone (or "crushed" portion of skull) with depression of the bone in toward the brain.

Evacuate Epidural Abcess: An epidural abscess is an inflammation that includes a collection of infected material (pus) located between the outer membrane covering the brain and spinal cord (the dura) and the bones of the skull or spine.

Evacuate Epidural Hematoma: The brain is enclosed in the skull, which is a rigid, solid bone. Surrounding the brain is a tough, leathery outer covering called the dura. The dura attaches to the brain, just beneath the skull bone. The dura normally protects the brain and keeps it nourished with blood and spinal fluid. When a person receives a severe blow to the head, the brain bounces within the cavity. This movement of the brain structures may cause shearing or tearing of the blood vessels surrounding the brain and dura. When the blood vessels tear, blood accumulates within the space between the dura and the skull. This is known as an epidural hematoma, or blood clot, at the covering of the brain.

When the blood accumulates between the dura and skull, swelling of the brain occurs. There is no extra room within the skull to allow for the brain to swell and for the blood to accumulate. The only way the brain can compensate is to shift the delicate structures out of the way. This can cause pressure on vital functions, such as eye opening, speech, level of awakeness (or consciousness), or even breathing. Generally, an epidural hematoma can cause serious problems and must be removed to prevent increased swelling of the brain. The procedure of choice for removal of an epidural hematoma is surgery to remove the blood clot.

Causes: An epidural hematoma can happen to anyone, at any age. Some common causes of epidural hematoma include:

A blow to the head, such as in a motor vehicle crash, assault or bicycle accident
Falling down and striking the head

Evacuate Intracerebral Hematoma: Intra-axial hemorrhages are potentially deadly because they can increase intracranial pressure in delicate brain tissue or reduce its blood supply, causing ischemia. The other category of intracranial hemorrhage is extra-axial hemorrhage such as epidural, subdural, and subarachnoid hematomas, which all occur within the skull, but outside of the brain tissue.

If the physical trauma to the head ruptures a major blood vessel, the resulting bleeding into or around the brain is called a hematoma. Bleeding between the skull and the dura, the thick, outermost layer covering the brain, is termed an epidural hematoma. When blood collects in the space between the dura and the arachnoid membrane, a more fragile covering underlying the dura, it is known as a subdural hematoma. An Intracerebral hematoma involves bleeding directly into the brain tissue.

All three types of hematomas can damage the brain by putting pressure on vital brain structures. Intracerebral hematomas can cause additional damage as toxic breakdown products of the blood harm brain cells, cause swelling, or interrupt the flow of cerebrospinal fluid around the brain.

Evacuate Subdural Empyema: Subdural space infected from nasal sinuses or as a result of neurosurgical drainage

Evacuate Subdural Hematoma (SDH): Surgery for acute SDH consists of a large craniotomy (centered over the thickest portion of the clot) to decompress the brain, stop any active subdural bleeding, and evacuate any hematomas in the immediate vicinity of the acute SDH.

Subdural hematomas are one of the three types of extra-axial intracranial hemorrhages (along with subarachnoid and epidural hemorrhages) and usually occur as a result of trauma. Deceleration injuries are often the cause of subdural bleeding from rupturing of veins via a shearing mechanism. Other entities, such as child abuse and ventricular decompression, also can result in subdural bleeding.

The meninges are composed of the dura mater, arachnoid mater, and pia mater. A space potentially exists between the arachnoid and dura (termed the subdural space), which, unlike the epidural space, is not confined by the cranial sutures.

By far the most common cause of a subdural hematoma is severe brain injury after a car accident or a fall from a great height. These traumatic subdural hematomas are always associated with considerable brain damage, and occur immediately after the injury.

NERVE INJURY

Neurolysis: Neurolysis is the destruction of nerves or nerve tissue or freeing a nerve from inflammatory adhesions by radio frequency, heat, cutting or by chemical injection.

Nerve Graft: Procedure that removes part of a healthy nerve, attaching it to injured nerves in order to repair them.

Open Reduction: Realignment of a fractured bone after incision into the fracture site.

Postero-lateral Fusion: Postero-lateral spinal fusion is achieved through an incision in the middle of the back by joining adjacent vertebrae with screws and rods but without interfering with the disc. Small pieces of bone are usually taken from the back of the pelvis, through the same skin incision, and are placed along the back and side of the vertebrae to be fused.

Internal fixation devices may be used in an attempt to improve the rate of fusion. When they are used, screws, rods or plates can stay in the body forever but in some cases these implants can cause discomfort, irritate the overlying muscles, become loose, infected or break, in which case they may need to be removed.

Remove Foreign Body: Craniotomy to surgically remove a foreign body (any object originating outside the body) from the brain.

Repair CSF Leak: CSF leak is an escape of the fluid that surrounds the brain and spinal cord from the cavities within the brain or from the central canal in the spinal cord. This happens when the dura, the membrane that surrounds the brain and spinal cord and contains the cerebrospinal fluid (CSF), tears, usually under the following circumstances:

Spontaneously
After spinal, sinus, head, or brain surgery
After penetrating head trauma.

CSF leak can also be caused by a lumbar puncture (spinal tap) or by epidural placement of catheters for anesthesia or pain medications.

Spinal Trauma: Skull tongs are used in traction to stabilize both the head and spine for conservative treatment, cervical fractures, and dislocations - a cervical traction. Cervical traction is used for minor neck injuries without obvious fractures i.e. Whiplash injury, neck muscle spasm, conservative treatment of cervical disk lesions. More severe trauma will require the spine neurosurgeon to reconstruct the spine using a combination of screws, metal plates and rods.