“All you need to know about Spine Fusion Surgery”
— Get Well in India
Spinal fusion is a surgical procedure to join two or more vertebrae into one single structure. In a simple language, it is like a welding process. The aim of the surgery is to stop movement between the two bones and prevent back pain. Once the bones are fused, there is no friction.
During spinal fusion, a bone or a bone like material is placed within the space between two spinal vertebrae using metal plates, screws and rods, so they can heal into one solid unit.
Fusion will take away some spinal flexibility, but most spinal fusions involve only small segments of the spine and do not limit motion so much.
The vast majority of patients who have low back pain will not need surgery to treat their condition. However, sometimes surgery can help when all other methods have failed to bring relief. If medicines, physical therapy, and other treatments (like steroid injections) haven’t helped your back pain, this surgery might be an option. This is recommended only if the Doctors exactly know which point
Dr. Vikas Gupte
Spine Fusion Surgeon
Dr. Hitesh Garg
Spine Fusion Surgeon
The lumbar spine, or lower back, consists of five vertebrae numbered L1 through L5. These vertebrae are the largest in the spine and support the head and trunk. L5 vertebra transfers upper body weight through the sacrum and pelvis into the legs. The sacrum consists of five naturally fused vertebrae and provides stability to spinal column. Although the bones of sacrum are fused, they are numbered S1 through S5. The pelvis is often referred to as the hip.
Each lumbar vertebra shares a basic structure:
- Vertebral body: It looks like a large kidney-shaped bone from the top view.
- Pedicles: They are horizontal cylinders of bone that project outward off the back of a vertebral body.
- Lamina: It is a thin plate of bone that forms an arch behind a vertebral body.
- Articular processes: These are upward and downward bony projections from the lamina.
- Facet joints: Smooth cartilage-lined structures at the ends of the articular processes.
- Transverse processes: Long, thin bony sideway projections at the junction of the pedicle and lamina
In between each vertebral body there exists a disc which are numbered according to their spinal position. For example, the L4-L5 disc is found between the 4th and 5th lumbar vertebrae.
The lower back discs are the largest in the spine. The discs match the kidney-shape of the vertebrae. There are two parts to each disc. The outer layer and the inner layer. The outer layer consists of rings of cartilage called the annulus fibrosus which are flexible in nature. The inner layer consists of annulus, which is a jelly-like substance called the nucleus pulposus. The nucleus contains mostly water to help maintain hydrostatic disc pressure (which maintains balance of the body).
Discs perform two important functions:
- Act as spinal shock absorbers between the vertebral bodies.
- Function as flexible pivots to help provide motion between the vertebrae.
The spinal cord is a firm, yet delicate structure of nerve tissue. It cannot be displaced, only a serious neurological injury can displace or move the spinal cord. The spinal cord ends at L1 and below L1, there is a thick sack of fluid in a case like structure, which are nerves that make up the cauda equina. Spinal nerves exit the cauda equina through small holes called lateral foramina and control leg functions and sensations.
Spinal fusion permanently connects two or more vertebrae in your spine to improve stability, correct a deformity or reduce pain. Your doctor may recommend spinal fusion to treat the following spine problems:
- Broken vertebrae: There are some broken vertebrae for which surgery is not required and can be healed using other treatments. But if a broken vertebra makes your spinal column unstable, spinal fusion surgery may be necessary.
- Deformities of the spine: Spinal fusion can help correct spinal deformities, such as a sideways curvature of the spine (scoliosis) or abnormal rounding of the upper spine (kyphosis).
- Spinal weakness or instability: If there’s abnormal or excessive motion between two vertebrae your spine may become unstable. The very common reason could be severe arthritis in the spine.
- Spondylolisthesis: If you have spondylolisthesis and if the condition is causing severe back pain or nerve crowding that produces leg pain or numbness.
- Herniated disc: Spinal fusion may be used to stabilize the spine after removal of a damaged (herniated) disk.
- Any Fracture, severe infection or tumor.
You may be a candidate for fusion if you have:
- Chronic or severe pain that is either sharp, dull, radiating, or throbbing
- Loss of motor functions
- Difficulty walking, sitting, or standing straight
- No effect of physical therapy or medication
- Numbness or weakness in the extremities,
- Weakness or loss of balance
Your orthopedic surgeon will suggest some diagnostic tests like MRI to look for disc issues and check nerve status, CT scan for ruling out bones and joints issues, myelogram or electromyogram, x-ray to check for arthritis. After reviewing your reports your orthopedic surgeon will recommend the best option for you.
Surgical Procedure Details
All lower back pain don’t require surgeries. But if your condition is one that requires surgery, rest assured that spinal fusion has a huge success rate. There are two types of spinal fusion surgeries:
- Lumbar Fusion: This is a commonly done surgical procedure mainly to treat degenerative disc changes in lumbar spine which causes pressure on the spinal cord nerves. The goal of the lumbar fusion is to have the two vertebrae fuse together so that there is no motion between them. Removal of the intervertebral disc or bone spurs can reduce some of the pressure on the nerves, helping to reduce pain. Additionally, by fusing the two vertebrae together will stop the formation of bone spurs at that location, further reducing pain and potential nerve injury.
There are many different specific techniques to try to fuse the vertebrae together. Spinal fusion surgery can be performed either through an incision in the back, the abdomen, or a combination of both. In many cases metal screws and rods are placed from the back into the bones to hold them steady while the fusion occurs. The spine may be approached and the graft positioned either from:
- Posterior Lumbar Interbody Fusion (PLIF) : This procedure is done from the back and includes removing the disc between the two vertebrae and inserting bone into the space created between the two vertebral bodies.
- Anterior Lumbar Interbody Fusion (ALIF): This procedure is done from the front and includes removing the disc between the vertebrae and inserting bone into the space created between the two vertebral bodies.
- Transforaminal Lumbar Interbody Fusion (TLIF): This procedure is also performed from the back.
- Oblique lateral lumbar interbody fusion (OLLIF): This procedure is performed from the side .
- Cervical Fusion: It is also one of the common surgeries performed to treat lumbar pain. In this surgery, the lamina (the bone in the back of the vertebra) at one or more segments is removed. The main aim of this surgery is reducing pressure on the nerves caused by mainly age related changes in the spine. It is also done to treat other conditions, such as injuries to the spine, herniated discs or tumors.
There are different methods of doing a cervical spinal fusion:
- Bone can be taken from elsewhere in your body or you can also go for bone graft. The bone is used to make a bridge between vertebrae that are next to each other. This bone graft stimulates the growth of new bone. Man-made fusion materials may also be used to fuse the bones.
- Metal implants can be used to hold the vertebrae together until new bone grows between them.
- An entire vertebrae can be removed and then spine may be fused.
- Spinal disc can be removed and the adjacent vertebrae can be fused.
This procedure can be done through an incision on the front (anterior) or back (posterior) of the neck.
After the first two weeks after the operation, the patient shouldn’t go to work, or participate in organized activity. This is a time to heal, both physically and mentally. During this time, the dressing on the wound should not be disturbed. This means sponge bathing only until the follow-up clinic appointment in two weeks.
At the follow-up appointment, the surgeon will inspect of the wound and change the dressing or bandage.
Over the course of a year, the patient’s activities will return to normal:
- First Six Months: No strenuous physical activity. Start walking everyday. Don’t lift weight. Avoid running or jumping or jerks are allowed.
- Six to Eight Months: At six months, an X-rays will be performed. If everything comes out well, then you can increase walking and also start other physical activity but for shorter durations. You can also resume swimming, if you like.
- Eight to 10 Months: You can start bicycling, where the foot is on a pedal as the lower limb rotates. It will be a very good exercise for you. Also, climb stairs.
- Ten to 12 Months: Running, jumping and solo sports are allowed.
After an year, x -rays will be taken again. If all is well, the patient will be allowed to return to unrestricted activities as well.
The benefits of surgery appear to last for 8 to 10 years. Here are some benefits of spine fusion surgery:
- Relieve pain
- Relieve numbness and tingling
- Relieve weakness
- Restore nerve function
- Stopping of abnormal motion in the spine
- Restore disc height
- Stabilize the spine