Spinal fusion surgery

Spinal fusion surgery is an intervention to stiffen the spine. Doctors connect and fix two or more vertebral bodies with the help of screws, rods or plates. These grow into the vertebral body and remain there permanently. The vertebral bodies stiffened in this way are then immobile and no longer function as usual as joints. After a spinal fusion operation, the mobility of the spine is partially or completely restricted. The aim of the procedure is to relieve chronic back pain, to stabilize the spine again, to give it more support and to protect the surrounding structures (spinal cord, blood vessels, organs).

Spinal fusion surgery is a serious procedure on the spine. The spinal stiffening is final and cannot be reversed. The results cannot be “corrected” either, for example if the spine is not sufficiently stable despite the operation or the pain does not go away.

When do doctors perform spinal fusion surgery?

Spinal fusion surgery is only an option for very serious diseases and injuries to the spine - it is usually the last possible treatment option for doctor and patient. It is also the last treatment option if other conservative measures (without surgery) have not been sufficiently successful. The most common reason for this procedure is chronic back pain.

Examples of the use of spinal stiffeners are:

• Injuries to the vertebrae (e.g. vertebral fractures) or the spine after an accident
• Vertebral sliding (spondylolisthesis): The vertebral bodies slip and are shifted to each other. The operation restores and stabilizes the profile of the spine (reduction spondylodesis)
• Scoliosis : The spine is bent sideways and twisted at the same time; the spondylodesis straightens the spine again (corrective spondylodesis)
• Wear of the intervertebral discs and vertebral bodies, for example in the neck area (cervical spondylosis, cervical = to the neck)
• Wear of the vertebral joints (facet syndrome, vertebral joint arthrosis) and spine (spondylarthrosis)
• Tumors in the spine
• degenerative diseases of the nerves
• Bruised nerves

Spondylodesis is performed by specialists in neurosurgery, orthopedics and trauma surgery in hospitals.

Spinal fusion location: cervical spine, thoracic spine or lumbar spine?

The place where doctors perform the spinal fusion always depends on exactly where the injury or disease is located. In principle, spinal fusion surgery can be performed on all sections of the spine:

·        Cervical spine (cervical spine)

·        Thoracic spine (BWS)

·        Lumbar spine (lumbar spine)

However, doctors often do the spinal stiffening between the thoracic and lumbar spine.

Access to the spine: anterior or posterior

The operation can be performed from the front (the abdomen = ventral ), from the back ( dorsal ) or from both sides. Doctors often remove part or all of the vertebral bodies as part of the operation. Doctors also differentiate between spinal fusion surgery with and without implants.

An example: The cervical spondylodesis (cervical = to the neck) is the standard for a herniated discthe cervical spine. Doctors access the disc through a small incision in the front of the neck. Then they often replace the intervertebral disc with a so-called cage. This is a placeholder (prosthesis) in the form of a small basket. The spinal fusion cage is made of metal, plastic or ceramic (e.g. titanium, carbon or poly-ether-ether-ketone = PEEK). The cage is just as high as the removed intervertebral disc and ensures that the anatomy of the spine is correct again. In addition, doctors bring in the body's own material, for example bone chips from the pelvis, or artificial bone fillers. These help to ensure that the vertebral bodies subsequently grow together better. Also with degenerative diseases, injuries,

Spinal fusion surgery: duration and procedure

The spondylodesis operation is always carried out as an inpatient in a hospital under general anesthesia. The procedure should always be carried out by a surgeon who has extensive experience with the operation. Spinal fusion is often a major operation that requires extensive incisions. Sometimes the spondylodesis operation can also be performed using "keyhole surgery" (minimally invasive operation), for example in the case of a herniated disc on the cervical spine. Then smaller incisions are necessary and the operation is gentler on the patient. You have fewer side effects, recover faster and can leave the clinic earlier.

The duration of surgery for spinal fusion depends on the extent of the disease or injury. If the surgeon only joins two vertebral bodies together and stiffens them, the operation can be over within an hour or two. A spinal fusion over several and longer sections of the spine, on the other hand, takes significantly longer - it can even take several hours.

Spinal fusion - when not?

Spondylosis surgery is not advisable if patients suffer from bone loss ( osteoporosis ) or multiple tumor foci in the spine. Even if you have had radiation therapy on the spine, usually for cancer, it is not recommended.

Spinal fusion - follow-up treatment

Most patients can get up soon after the spinal fusion surgery, but they have to be very careful with their movements . It is best to have a physiotherapist in the clinic to show you which movements are good and which are better to avoid, for example jerky changes in position or turning movements. There are also a fews things to consider when lying and sitting correctly. Which positions are allowed depends on the area of ​​the spine in which the spinal fusion surgery took place. First of all, patients have to learn to deal with the limited mobility of the spine and to get used to it.

In order to additionally stabilize the spine, patients wear an individually adapted support corset for a period of time (around six weeks) , which they take off gradually. Only when this has happened does rehabilitation take place in the case of a spinal fusion - this is indispensable after the operation, preferably as an inpatient in a rehabilitation clinic. As a rule, the statutory and private health insurances or the pension insurance cover the costs for rehab after a spinal fusion.

Spinal fusion and rehab - your back learns that

The most important component of rehab is physiotherapy, which is individually tailored to the patient. You will learn gentle, back-friendly and painless movement patterns, sequences of movements and behaviors. In this way you slowly get used to your spine again to withstand loads and improve its mobility. In addition, physiotherapists use special exercises to train and strengthen the muscles and build them up again. Because the following applies: Strong back muscles are always the best protection against further back problems.

Spinal fusion - consequences

In the first few weeks after the spinal fusion operation, patients are not allowed to work hard physically - neither in their free time nor at work. The wounds have to heal first and the spine as well as everyone has to get used to the restricted mobility. However, light office work or work is possible just a few weeks after the operation. Patients also have to forego sport after the spinal fusion surgery. Patients should always discuss all questions relating to sports, leisure activities and their profession in detail with their doctor.

Spinal fusion surgery involves certain risks :

·        Very rarely does the surgeon injure nerves or surrounding structures of the spine; Permanent sensory disturbances (abnormal sensations, numbness) and restrictions of mobility are possible.

·        The bone doesn't heal properly.

·        General operational risks: infections, bleeding, impaired wound healing, pain, scars, growths, adhesions.

Spinal fusion can also have long-term consequences :

·        The screws, rods or plates can loosen or slip over time. They can also break, for example if excessive mechanical forces act on the implants.

·        After spinal fusion surgery, patients have an increased risk of blood clots ( thrombosis ) because they are only allowed to move to a limited extent in the first few weeks afterwards.

·        Damage to neighboring vertebral bodies can occur because they are exposed to excessive loads and strains due to the stiffening - back pain is the result, and possibly a new operation.

·        Restrictions of movement due to the stiffening.

However, the spinal fusion surgery usually achieves good results and the back pain improves in many cases. Today there are dynamic systems on the market in which a residual mobility of the operated vertebrae is retained (dynamic stabilization). The vertebrae are stabilized by a partially movable rod, but they still remain movable to a certain extent. However, this methods is only suitable for certain clinical pictures.

  techdirtblog  slashdotblog   justhealthguide  healthandblog  supercomputerworld