Relief For Back Pain

Posts Tagged ‘surgical’

Spinal fusion has become a very common surgical procedure in the United States over the past 10 years. There are many diagnoses that range from fractures of the spine to severe degenerative disc disease that prevent patients from being able to stand or walk are best treated with a surgical remedy. This article is intended to provide a basic review of the many spinal fusion options that are available.It is best to talk to a fellowship-trained spine surgeon who will be able to give you a complete picture of all of the devices available that are recognized for quality and reliability or to help you rule out those that are not advisable.

As the number of spinal fusions has increased, the variety of procedures and hardware alternatives that are available has also increased. It may be easier to understand why there are so many types of fusions if you consider how fractures need to be fixed with fusion. With broken bones, there is usually little question about the wisdom of providing casts or plates and screws to stabilize bones that need to be realigned or stabilized. Spinal fusion provides the same stability for the spine as is used for other fractured bones. What is a spinal fusion? Screws and rods in the spine are used to keep bones from moving as the bone graft that is placed allows the stabilized bones to form a connection across a previously mobile disc space. The growth of bone between 2 previously mobile bones is called fusion.

Standard Fusion Technique

Initially, fusion of the vertebral bones was done by laying bone graft between the bones, to provide a scaffolding across which the native bone cells could grow. As the patient s bone cells move across the bone graft, they are able to incorporate the bone graft into the patient s own bone structure, forming a complete connection called a fusion. Bone graft is of primary importance in allowing the vertebral bones to fuse across a previously mobile segment. Studies of patient s with fusions done with bone graft alone have shown a relatively good rate of incorporation when patients are placed in back braces for 3 months or more. Because of the inconvenience and discomfort of the bracing, pedicle screws and rods have been added to provide an internal support that obviates the need for external supports. Internal screws and rods have increased successful fusion rates, as well as allowed patients to become mobile very quickly after the spinal fusion.

Interbody Fusion Cages

As the skill of the surgeon s has grown when applying screws and rods to the spine, we have looked for better ways to gain improved results.Now, it is possible to put bone graft around the back of the spine, as well as into the disc spaces. With these improved grafting methods, we are able to safely access the lumbar disc from the back of the spine. Adding bone graft to the disc increases the surface area for healing and should improve the overall success rate of the spinal fusion. Interbody grafting can be done from several different approaches, as access to the disc space can be achieved from multiple directions.

XLIF

This acronym stands for extreme lateral interbody fusion. XLIF is a newer device designed to provide a carrier for bone graft and support to the disc space. It is placed through an incision on the patient s flank. By making an incision on the patient s side, the abdominal contents can be moved out of the way for a good view of the spine. Unfortunately, there are some significant nerves in the front of the spine that are very sensitive to being moved. This type of access to the spine can lead to weakness in one leg because of the sensitivity of these nerves.At this time, there are no long-term studies that demonstrate that this procedure is a success.

AxiaLif

This is another fusion device that has received some attention, due to its being touted as the least invasive spine fusion .This device is placed across the lowest disc space by access from the front of the sacrum (a large, triangular bone at the base of the spine, wedged between the two hip bones). By placing instruments through a small incision near the rectum towards the spine, the disc is accessed through a series of cannulas (hollow surgical tubes) and drills. This allows the disc material to be removed from the disc space. After the disc material is removed, bone grafting can be placed into the hole that is created. This disc space is then supported by a tapered screw placed into the bones. So far, this device has had minimal post-surgical study and is most likely best done in conjunction with standard screw and rod fusion techniques.

Flexible Rods

There has been some recent excitement around rod and screw systems that are so-called non-fusion fusion devices. This confusing name infers that, although the intent of the screws and rods is for the bones to not move, these devices are designed to allow some movement. As was discussed earlier in this article, fusion is the solid connection of bones that had previously moved.The idea of these flexible rods is to provide enough stability to allow the bones to fuse together, but not enough to change the spinal forces. This is termed a soft-fusion .At this point, there is no concensus as to how much or how little support is needed to achieve this. It is known that current screw and rod systems provide enough support to allow a fusion to occur while providing complete immobility of the vertebrae. Other than this complete connection, the amount of support less than complete immobility has not been defined and at this point is still under investigation.

Disc Replacement

Disc replacement was developed as an alternative to fusion and is suggested for those discs that have ruptured, but in which the bone structure is still good. If only the disc has gone bad, removal of the disc leaves a space that we normally fill with bone graft to promote fusion in the neck or lower back. With the development of the disc replacement, the space that is left from disc removal can be filled with a device that allows motion, rather than fusion. This is a complete reversal in the approach to disc removal; from complete immobility to complete mobility. Disc replacement is intended to maintain the motion in the spine. This reconstruction of the spine should maintain the forces across the discs in the spine to prevent the other discs from deteriorating any more rapidly than their normal degenerative process. Disc replacement in the lumbar spine has met with some success in well-selected patients. It has not been a panacea for all patients with low back pain or degenerative disc disease.Disc replacement in the cervical spine has had good success, as most neck fusions are done for bad discs with the bones still in good condition.

Improved training, including advanced specialty training in fellowship programs, as well as improved implants, has decreased most surgical procedure times to 2 hours or less. Historically, older techniques have been known to take 4-6 hours for the operation alone. By decreasing operative times, surgeons have seen decreased complications from the anesthesia, as well as decreased risks of infection and blood loss. Most surgeries under 2 hours will not require a blood transfusion.

A well-informed patient, who understands the benefits and the risks of their surgery, can fully participate in the choices that need to be made about their surgery. If you have been told that you need a spine fusion, ask questions and do your research. It is appropriate to ask your surgeon about their experience performing spinal fusions, how many of the fusion procedures they perform, how long the operation will take and the likelihood of needing a blood transfusion. Selecting a well-qualified surgeon can help ensure the best outcome for you and the success of your spinal fusion.

Other Related Posts:

Back Pain Treatment – Is Spinal Fusion The Last Option

Some patients said they had spinal fusion success in the short during the operation of spinal fusion to relieve their back pain, the segment of the spine is now fused an additional burden on the adjacent vertebrae, which may indicate …

2-18-10, 2 am- Ally still in hospital, but recovering/ Ways to help

If it snows, my mom is unable to drive the girls due to her spinal fusion healing, but so far she is doing wonderful handling them and feeding them. Something that can be difficult while in the hospital and soon after discharge is meals …

Advanced Medical Techniques For Spinal Cord Surgery

Spinal fusion is surgery to correct problems in the spine bones (vertebrae). The surgery stabilizes the back by permanently placing certain bones in the spine together. Fusing means two bones are permanently placed together so that … Spinal cord surgery in India is one of the best options available for the international as well as Indian patients across the globe seeking treatment for spine surgery. Patients are in a constant supervision of abroad expert surgeons of …

The Spinal Question

Older fusion methods and inadequate diagnostic approaches left surgeons with few options for treating these patients, so some patients were given fusions as a last attempt to improve their pain . Most patients with lower back pain and …

Standing Posture

However, this treatment option is quite inconvenient for the patient as it has to be worn up to 24 hours a day and is quite uncomfortable. *Surgery: For scoliosis, it is specifically referred to as Spinal Fusion Surgery wherein a spinal …

Tuesday, February 9th

If the later is the case, a spinal fusion has been mentioned as a option. You have seen people with a spinal fusion before, their necks appear to be sunken down to their shoulders and when they look left or right, up or down, …

Spinal Fusion Surgery To Relieve Low Backache

Posterolateral Gutter Fusion • Posterior Lumbar Interbody Fusion • Anterior Lumbar Interbody Fusion • Anterior/ Posterior Spinal Fusion. These spinal fusion surgery procedure options are chosen on the basis of the underlying cause of …

Effect of Wearing a Corset After Lumbar Spinal Fusion

“Children with scoliosis (curvature of the spine), whether or not it has been stabilized with spinal fusion, may have some left-right tilt in the pelvis,” Seiberlich says. “In such cases, we can use the seating system to minimize the …

 

 

Technorati Tags: bones, degenerative, Disc, disease, fractures, fusion, fusions, options, realigned, remedy, spinal, spine, stabilized, surgeon, surgical, types

Spinal fusion is a surgical procedure that many back pain sufferers don’t understand. Many people have heard horror stories about people who have had back surgery and never recovered.

Many patients think a spinal fusion will cause their spine to become completely rigid, and they envision a future of pain and stiffness  and being unable to bend their backs or touch their toes, afterwards. Over the past decade, spinal fusion has also had a less than bright reputation as a treatment for pain. Given the overall perception that fusion of the spine is a delicate surgery with questionable outcomes, patients are quite concerned about proceeding with a fusion. This article will help to dispel many of the misconceptions that surround this treatment and why it is important to understand the procedure, when it should be performed and who might benefit from a spinal fusion.

What is Spinal Fusion?

Spinal fusion is a surgical procedure designed to provide stability to an area of the spine that has too much movement or movement that causes pain, tingling, numbness or weakness in the arm or leg. The object of a spinal fusion is to connect the bones (vertebrae) that were previously too mobile and form a connection of bone in the spine that is more rigid.

A History Lesson

Orthopaedic surgeons have long applied casts to broken bones to provide support to fractures and allow the bones to heal. This external support keeps the bones from moving. Why is this important? When there is too much movement between broken bones or bone fragments, the repair cells are prevented from being able to connect the bone fragments together, so their process of healing will stop.

As orthopedic surgeons have progressed in the use of technology, plates and screws, called internal fixation devices, are now applied to fractured bones. These rigid internal fixation devices are stronger, and they add more support to the fractured bone. Plates and screws have been able to replace bulky external casting in a large group of fracture types.

The same treatment principles are used by the orthopedic spine surgeon. There was a time when fusions were supported with external bracing. This external support, provided by casting or rigid bracing, has been replaced with internal rods and screws. Using these internal supports provides stronger bone connections that decrease motion even more. As a result, the number of successful fusions has increased. The internal support of the spine is stronger, allowing patients to get up and out of bed and walk the day of surgery and to return to their usual activities in 6 weeks. This is a far cry from the days of original spinal fusions that were supported with a cumbersome hard plastic brace or cast, leaving patients with limited mobility or bed rest for many months.

Spine surgeons are now better able to determine which patients will be helped with a spinal fusion. Advanced imaging studies, including MRI and bone scans, as well as the use of diagnostic injections, help today s spine specialist more accurately diagnose patients who would benefit from spinal fusion. Advances in surgical techniques and components, including the development of better screws and rods, also have greatly improved patient results. Improved diagnostic and surgical training, including advanced training in spine fellowship programs, has helped spine surgeons interpret and use these advances in technology to obtain better outcomes for patients.

Who Needs a Spinal Fusion?

As with all surgeries, there are proper uses that will result in good outcomes for patients with spinal fusion.

In patients where the spinal bones have begun to slip and cause pressure on the spinal nerves (spondylolisthesis), this excessive movement may need to be stopped to prevent worsening of the nerve pressure. During surgery, these patients will have the bone spurs and disc protrusions removed from around the nerve roots and spinal cord, which may destabilize the bones of the spine and cause the bones to slip more. Inserting screws and rods in these bones will prevent the bones from slipping any further after surgery and also may be used for correction of the original slippage.

Use of screws and rods can also provide stability and correction for patients with scoliosis. Scoliosis is the bending of the spine in an abnormal direction. The curve of the spine may increase with time or may be painful as the curvature of the spine increases. If the patient has a large curve or the curve is continuing to get worse, screws and rods are used to correct the position of the spine and prevent the curve from worsening.

In patients with obvious bone destruction from fracture, tumor or infection, stabilizing the bones with screws and rods will provide the support that is needed so the underlying disease can be addressed. The structure of the spine can be improved while the patient receives chemotherapy or radiation. By removing the tumor in the spine, the back pain related to an expanding tumor can be relieved and the patient can remain mobile, which helps to prevent pneumonia and blood clots. Being ambulatory, while receiving chemotherapy and radiation, also improves the patient s mood and outlook while coping with their disease.

Who is Not a Candidate for Spinal Fusion?

Most patients with disc herniations or pinched nerves will not need a spinal fusion. These conditions can be treated with simpler procedures that allow the removal of pieces of discs or bone spurs that do not increase the movement in the bones.

The more difficult indication for spinal fusion is in the patient with severe pain in the back. Degenerative disc disease is the leading cause of back pain in the United States, but back pain can have many underlying causes. One of the reasons that spinal fusion developed a bad reputation is that they were performed as a remedy for back pain that did not respond to other forms of treatment. Older fusion methods and inadequate diagnostic approaches left surgeons with few options for treating these patients, so some patients were given fusions as a last attempt to improve their pain . Most patients with lower back pain and degenerative disc disease will not need a spinal fusion.

What To Expect From Spinal Fusion?

It is expected that most patients will be back to their usual state of health and activity at approximately 6-8 weeks after their fusion surgery. Most patients will be pain-free after their spinal fusion. It is important to choose a well-trained surgeon to make educated decisions about your diagnosis and treatment. With the combination of the proper diagnosis and properly applied spinal fusion most patients will have successful outcomes.

Other Related Posts On Spinal Fusion:

 

Spondylolysis Surgery Options

Spinal fusion is definitely done most commonly on the lumbar portion of the spine, which is the method that is used when it comes to spondylolysis surgery options. It is also used to treat other problems as well. This type of surgery is …

Spinal Fusion Surgery Over-Servicing

Lead study author Professor Ian Harris, director of orthopaedics at the Liverpool Hospital in Sydney, says the indications for surgery may change over time, but this does not explain th fef e disproportionate increase in spinal fusion …

Sciatica After Spinal Fusion

Sciatica After Spinal Fusion story sent in by Ko and published on Sciatica-Pain.Org.

Surgery and spinal fusion

Surgery and spinal fusion. So this is it, the time has come, I’m preparing all my things to leave on the 12th now and preparing my shops so to close them because I won’t be able to take in any orders while in the hospital, …

Bruce: Your Answer to Your Back Surgery

I’m about a 15 handicap and play about once a week, I am scheduled for l-5, S-1 spinal fusion on Dec 17 of this year. It’s all the disc about are very healthy, Do you know anyone in the last couple of years that has this type of surgery …

Surery in India: cheap cost option

Spinal Fusion surgery in India helps patients in their back pain related treatments by packaging their medical trip to India and it also offers a full compliment of surgical as well as physiotherapy services exclusively to international …

Dr Davis’ Back & Wrist Pain Blog: A Nonsurgical Treatment Option …

If you are overweight and you go on a weight loss program and start some exercises after successful nonsurgical spinal decompression it may last forever. Hey…you can always have surgery. But once you have spinal fusion you can never …

 

 

Technorati Tags: back, degenerative, Disc, disease, fusions, fusuin, lower, nerves, numbness, orthopaedic, pain, prevent, procedure, severe, spinal, spinal fusion, Spondylolisthesis, surgeons, surgical, tingling, Treatment, vertebrae, weakness