Common surgically-treated spinal conditions
W hen discussing spinal disorders that can be treated with surgery, it is crucial to set forward a few essential considerations. First and foremost, surgery should not always be regarded as a last resort. The modern approach to treating spinal disorders involves a multi-step process: from conservative to interventional treatments, from diagnostic imaging to physical therapy. In this process, surgery may be implemented at the beginning, in the middle, or at the end, depending entirely on the patient's clinical condition. In this complex scenario, with the latest technology, including robotics and intra-operative navigation systems, minimally invasive surgery can now be safely performed in an ever-increasing number of cases. It is important to note that only the specialist's opinion will determine whether surgery is the appropriate solution.
With current technological advancements, robot-assisted surgery is an highly effective option for procedures requiring stabilization between two or more vertebrae using synthetic devices, such as pedicle screws, plates, and intervertebral prostheses (cages). The following conditions are the most frequently treated with spinal surgery in their severe and degenerative forms. When possible, robotic spinal surgery is used, offering numerous benefits. However, being a relatively recent technology, new applications of robotics are being explored every year, allowing for procedures such as spinal tumor resection, osteotomy, and spinal trauma surgery. It is always recommended to consult a specialist robotic spine surgery to assess the possibility of intervention in specific cases.
Lumbar disc herniation
A herniated disc is one of the most common conditions and occurs when an intervertebral disc tears, resulting in a leakage of the nucleus pulposus that compresses adjacent nerve structures, causing pain and other discomfort. Herniation can occur in both healthy and worn discs. It is usually found in the lumbar spine, but is also frequently observed in the cervical spine, and often regresses spontaneously. In many cases, conservative treatment is sufficient, but when the nerve compression is severe and the pain intractable, surgery may be necessary, such as arthrodesis, which involves vertebral stabilization or fusion. Today, surgical robots in these cases provide significant support.
Cervical disc herniation
When a herniated disc occurs in the cervical spine—typically due to degenerative changes, trauma (such as whiplash), or overuse—they can cause pain as well as neurological symptoms in the shoulders, upper limbs, and hands. When conservative treatment fails, due to severe nerve compression and intractable pain, surgery may be required: a microsurgical procedure involving microdiscectomy with disc prosthesis.
Spinal canal stenosis
Spinal canal stenosis is the narrowing of the spinal canal, the cavity which contains the spinal cord and the nerve roots branching from it. Typically, this condition affects the cervical or lumbar regions and can arise from various causes, including congenital factors. When stenosis compresses the spinal cord or nerves in the lumbar spine, symptoms can vary in severity based on the degree and impact of the compression: sensory impairments in the arms or legs, muscle weakness, difficulty walking, reduced walking autonomy, and pain in the lower back or neck. When these symptoms become persistent and debilitating, conservative and analgesic treatments may no longer be sufficient. In such cases, a specialist may consider a laminectomy, foraminectomy or arthrodesis surgery. These procedures are also performed using minimally invasive techniques and the latest generation of surgical robots.
Degenerative scoliosis
Scoliosis is characterised by a lateral curvature and torsion of the spine. Depending on the degree of curvature, measured using the Cobb angle, there are various types of conservative therapies to correct it.
In cases of mild scoliosis (10-20° Cobb), postural gymnastics and physical therapy are recommended. For moderate scoliosis (20°-40° Cobb), correction with braces, corsets, or orthopedic supports is generally preferred. However, for severe scoliosis (over 40° Cobb), where the spinal column's morphology is significantly altered, or for degenerative scoliosis that develops and worsens in adulthood or old age and does not respond to other treatments, surgery should be considered. It involves stabilizing the spine with titanium rods fixed by screws, allowing for a secure correction. Robot-assisted surgery is highly recommended for this procedure due to its precision and minimally invasive approach.
Spondylolisthesis
Spondylolisthesis occurs when one vertebra slips over the one below it. It can be caused by congenital isthmic displacement or degenerative joint disease. This condition typically occurs in the lumbar and lower back regions, leading to back pain and sciatica. As always, the severity of the condition and its symptoms determine the course of treatment. In mild to moderate cases, pain is relieved with analgesic medication, and patients are advised to perform postural exercises, including muscle strengthening and core stability training. However, when the pain is severe, persistent, and incapacitating, and conservative treatment is unsuccessful, an arthrodesis of the affected vertebrae (typically L4, L5, and S1) may be performed. This procedure is greatly facilitated by the robotic technologies used in modern spine surgery.
Spondyloarthrosis
Spondyloarthrosis is the most common disorder affecting the spine, especially in developed countries where life expectancy is increasing. It is a form of arthrosis involving the structures of the spine and typically affecting the cervical or lumbar area. Caused by the natural aging of the spine's articular structures, such as intervertebral discs and vertebral joints, spondyloarthrosis (also known as spondylodiscitis or osteochondrosis) is among the spinal conditions treatable with robot-assisted surgery. Surgery is recommended for the most severe and degenerative forms that do not respond to conservative treatments such as analgesic therapy and physical therapy.
