Surgical Techniques

In decompression of the spine, anatomical structures that exert pressure on the spinal cord or nerve roots are generally removed surgically. These can be, for example, protruding parts of the intervertebral disc, thickened ligaments and/or ossifications. By removing these constricting structures, the spinal cord and nerve roots can be relieved, thus reducing symptoms. If the spinal column is still sufficiently stable after the decompression operation or if only small amounts of the anatomical structures - for example, only a small portion of the intervertebral disc - had to be removed, no additional implants are necessary.

If a disc has been removed because of any number of diseases, it can be replaced by a fusion implant. These implants are available in many different shapes and are made from different materials so that both the patient’s particular anatomy and different surgical techniques can be accommodated. They can be used along the entire spine from the cervical to the lumbar region. It is necessary to insert a disc replacement to maintain stability and create a connection between neighbouring vertebral bodies as well as to keep the shape of the spine by retaining the disc space. The aim is fusion of the implant with the vertebral body endplates of the neighbouring vertebrae, that is, bone grows through the implant and firmly anchors it in place.

If a cage is inserted into the cervical spine, the fusion can be stabilised with an additional plate or a dorsal fixation using a rod-screw system, depending on the individual circumstances of the patient. In the lumbar spine, on the other hand, the fusion must always be reinforced by an additional stabilisation, either with a plate or with a rod-screw system. An exception, however, are so-called stand-alone restorations, in which the fusion implants themselves have additional screws to be fixed directly to the adjacent vertebral bodies.

Possible SIGNUS solutions for cervical can be JASPIS ST (not for sale in the US) or NUBIC and for lumbar BIG ST (not for sale in the US) or WOMBAT (not for sale in the US). 

So that after removal of a disc the mobility of the affected segment and thus the balance of the entire spine can be restored, disc prostheses are used. They are inserted between neighbouring vertebral bodies into the disc space, like fusion implants. However, the aim is not for the disc prosthesis to fuse but instead it is supposed to provide the same mobility as a natural disc.

In this case of cause you don't need any additional stabilisation. 

The SIGNUS solution: ROTAIO (not for sale in the US)

If vertebrae or parts of the vertebral body have to be removed because of any number of diseases, they must be replaced by an implant so that the stability of the spine can be maintained. So that these implants are stably anchored, the top and bottom of the implants are placed directly on the neighbouring vertebral bodies and not on the discs.

Restorations with vertebral body replacement implants must always be additionally stabilised. This can be achieved by means of a plate and/or a rod-screw system.

Possible SIGNUS VBRs for cervical can be ATHLET or for thoraco-lumbar POSEIDON (not for sale in the US).

As a result of degenerative diseases, cancer or trauma, the spine may become unstable. So that the spine can continue to function as a protective and supportive organ, this instability must be corrected. One option is instrumentation with a rod‒screw system. This type of surgery is used primarily in the thoracolumbar and lumbar regions of the spine because a posterior approach, that is, surgery from the back, is advisable due to the anatomy. In this surgery, screws are inserted into the pedicle, the part of the vertebral arch next to the vertebral body. This location means that not only are the screws held firmly in place but it is also safe for the spinal cord and the nerves. After the pedicle screws have been screwed in and, depending on the stability of the bone, the spine is further stabilised using bone graft material, the rod is then inserted. This connects each of the screws and is curved specifically for each patient. This allows fusion over considerable distances or deformities to be corrected. This intervention can be carried out both in open surgery and using a minimally invasive procedure.

A SIGNUS solution: DIPLOMAT 

In addition to dorsal instrumentation using a rod-screw system, instrumentation can also be performed using plate systems. These are fixed to the vertebral bodies either at the front or at the side using screws. The aim is to support spinal fusion. The advantage of a ventral (anterior) or lateral instrumentation using a plate system is that an operation from the front, for example in the case of ACDF or vertebral body replacement, does not require additional surgery from the back, as is the case with dorsal instrumentation.

Possible solutions from SIGNUS can be TOSCA or ASCOT for the cervical spine and CONTACT (not for sale in the US) for the thoracolumbar spine.

As an alternative to fusion, spinal canal stenoses or other diseases whose symptoms decrease with flexion of the spine (forward flexion) can be treated with an interspinous spacer. Here, the implant is "clamped" between two spinous processes in order to widen the intervertebral windows and thus relieve the nerve roots. The advantage of this procedure is that only very small skin incisions are necessary and the surrounding anatomical structures are spared.

The solution from SIGNUS is called IMPALA (not for sale in the US).

If an SIJ syndrome cannot be successfully treated conservatively, an SI fusion by means of a fusion implant may be necessary. Since the spinal column and extremities meet in the sacroiliac joint and the pain usually radiates, the cause of the pain must be clearly determined before surgery. During the operation, the ligamentous apparatus and joint surfaces can be brought back to their normal state by controlled expansion. The implantation of a fusion implant is intended to achieve a permanent immobilisation of the joint.

The solution from SIGNUS is called DIANA (not for sale in the US).