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A
spinal fusion procedure aims to allow
two or more vertebrae to grow together through the formation of a bony
bridge between them. There are many ways to achieve this goal and many
approaches are driven by new technological advances. What ever modality is
used, the success of the procedure depends on the achievement of its goal:
To effect a
bony union between two abnormal motion segments in a patient that is
carefully selected according to strict criteria and indications.
Inappropriate fusions may
lead to not only lack of improvement but even worsening of
patient's condition. Fusions may require a long period of recovery to allow
the fused bones to grow together.
In the
Cervical Spine
this occurs faster and there is a higher success rate, with a rapid return
to work and normal physical activities. The most common approach is through
the front (see ACDF).
Other fusions are done through the back (C1-2
fusions,
Occipital/Cervical Fusions). Patients with a higher risk towards "non-fusion" (smokers, diabetics,
multilevel fusions) may benefit from an external bone growth stimulator
(Orthofix®).
In the
Lumbar Spine
a much longer period of bracing and limitation of physical activities is
required. This often a delays return to work. It may take up to six months
before patients are allowed to start physical therapy or return to sports.
There is a much higher failure rate, especially in smokers. In such cases
implantation if an internal bone growth stimulator
(EBI®Osteogen) may be beneficial. Many different approaches and
techniques are available:
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Posterior/Lateral Fusion (PLF)
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Posterior/Lateral/Interbody Fusion (PLIF)
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Anterior/Lateral/Interbody Fusion (ALIF)
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Extreme/Lateral/Interbody Fusion (XLIF)
- Bone Grafts and
Grafting Products
- A bone graft may come from your own
body (autologous graft - usually taken from the pelvic bone) or from a
bone bank (allograft). Expect postoperative pain if taken from the
pelvis. Bone graft substitutes, such as genetically engineered proteins
(BMP) have become popular as a complement to using bone grafts.
Various biomedical implants have been developed to act as structural
"spacers" to replace disks and resected
vertebral elements.
- Instrumentation
- Sometimes wires, rods, screws, metal
cages or plates are used to promote a fusion, especially if the spine is
unstable or if the operation is needed to correct a deformity.
There are many different systems from
many vendors, all tailored to address specific problems in the various
spinal areas (cervical, thoracic and lumbar/sacral). See:
Instrumentation.
- Procedures
- There are many different types of
fusion procedures, dependant on the spinal area involved and the goals
of the procedure. See: Procedures.
- Postoperative Care
- Spinal fusion removes some spinal
flexibility. This can be beneficial if movement between spinal segments
is what causes your pain. However, the fused spine needs to be kept in
proper alignment. You'll be taught how to move, sit, stand and walk in a
manner that keeps your spine properly aligned. Your doctor may also have
you wear a back brace after spinal fusion in order to provide support
and limit your motion. Periodic X-rays will be taken to monitor the
fusion process. At one point you may be started on a physical therapy
program to increase your strength and cardiovascular functioning.
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