Surgical principles in spinal surgery

This chapter is an introduction to spinal surgery, specific surgical techniques will be covered in other chapters. Preoperative considerations include the need for effective preoperative patient selection and careful consent. The optimal management of antiplatelet drugs and low molecular weight heparins in patients having spinal surgery is discussed but remains unclear. Perioperative considerations include careful patient positioning to protect the eyes and other pressure areas as well as the accurate marking of levels using X-ray. The use of microscopes and neurophysiology in spinal surgery is also discussed. The importance of fusion and the techniques used to promote it are covered in this chapter. Screw, rod, and plate design is explained. The principles of minimal access surgery down tubes or with dedicated implant kits is also considered. Postoperative considerations include the place of physiotherapy and venous thromboembolism avoidance.