A person’s spine is subjected to a lot of forces throughout its lifetime. It may be subjected to age related wear and tear or infections like tuberculosis. As a result it undergoes degeneration which gives rise to a variety of problems like spinal osteoarthritis, disc prolapse, spondylolisthesis, osteoporotic fractures, vertebral collapse etc. All these conditions manifest as severe pain in the back and radiating pain, numbness, tingling in the upper or lower extremities (lower leg or arm) due to compression of spinal nerves, spinal cord and spinal instability. When these symptoms become debilitating enough to preclude the patient’s day to day activity, a Spinal Fusion Surgery is advised.
What is Spinal Fusion Surgery?
Spinal fusion (spondylodesis or spondylosyndesis) is the surgical method of joining two or more verebrae. It is done most commonly in the lumbar region of the spine, but it is also used to treat cervical and thoracic problems. In this procedure, the damaged and painful vertebrae are fused into a solid stable bone. Fusion of the spine is used primarily to eliminate the pain caused by abnormal motion of the vertebrae by immobilizing the faulty vertebrae themselves, which is usually caused by degenerative conditions. However, spinal fusion is also the preferred way to treat most spinal deformities, specifically scoliosis and kyphosis. But, the results may vary according to the individual. Some may not feel any improvement in their back pain even after the surgery.
• Degenerative disc disease
• Spinal Stenosis
Lumbar spinal fusion can be divided into two categories|
• Posterolateral Fusion : In the back of the spine, the bone graft is placed in amid the transverse processes. With the help of wires and screws, the vertebrae is carefully fixed throughout the particles of every vertebrae. A rod is made up of metal which is attached on the side of vertebrae.
• Interbody Fusion : In this, the graft of the bone is placed in between the vertebrae and the area is generally engaged by the intervertebral disc. The disc is entirely removed in preparing for the spinal fusion. In order to maintain the disc height and spine alignment, a device can be placed in between the vertebrae. This device (intervertebral device) can either be prepared from titanium or plastic.
Then the fusion starts in between the vertebrae’s endplates. Interbody fusion is of 3 types-
o Posterior Lumbar Interbody Fusion (PLIF)
o Transforaminal Lumbar Interbody Fusion (TLIF)
o Anterior Lumbar Interbody Fusion (ALIF)
o Transpsoas Interbody Fusion (XLIF or DLIF)
In Posterior lumbar interbody fusion, the spinal fusion is achieved through a surgical incision made on the posterior (back) aspect of spine. It aims at fusion of two adjacent vertebrae in cases of spinal instability and associated back pain. It is a popular procedure as it gives excellent results. The procedure provides almost complete relief of symptoms in 90-95% of the cases and the patients are able to return to their daily activities within a few weeks. The patients can also return to most of their recreational activities.
PLIF surgery aims at achieving spinal stability through bony fusion by two ways:
The Open PLIF is the traditional technique which is performed using general anesthesia. The patient is made to lie down on his front side on the table with the low back exposed. A 3-6 inch long incision is made on the skin overlying the affected vertebrae. The skin and the fascia are cut open. The underlying muscles are retracted and the affected vertebrae are identified. Fluoroscopic X-ray is used to confirm the exact location of the affected vertebrae. Then a complete laminectomy (removal of the lamina of the vertebrae) followed by bilateral foraminotomy (enlargement of the foramen by removing the bony spurs) and/or discectomy (removal of offending disc) are performed.
This relieves the compression off the spinal nerves, allowing them to come to their normal size and shape. The area is checked for any remaining bony outgrowth or disc fragments that may compress the nerves. Autogenic bone grafts or Metal or plastic implants are fitted in the empty disc space for initiating bone growth.
The other method is the Minimally Invasive PLIF procedure which is performed using x-ray guidance. 2.5-cm incisions are made on either side of the lower back The muscles are gradually dilated and tubular retractors inserted to allow access to the affected area of the lumbar spine. The lamina is removed to allow visualization of the nerve roots. The offending disc material is removed from the spine and replaced with a bone graft and structural support from a cage made of bone, titanium, carbon-fiber, or a polymer, followed by placement of rod and screws. The tubular retractors are removed, allowing the dilated muscles to come back together, and the incisions are closed.
This procedure typically takes about 3 to 3 ½ hours to perform. There was less blood loss,tissue trauma, operative time, and quick recovery in this procedure as compared to the traditional one.Generally the patients can go home within 3-5 days after traditional PLIF and within 1-2 days after a minimally invasive PLIF
In most cases, spinal fusion can eliminate the pain and other symptoms. It is important for a surgeon to explain the options, and benefits of spinal fusion surgery. There are many advantages of Spinal fusion surgery such as:
• By fusing the level, there is less concern that the patient will need surgery again at that level. If the discs and/or facets are pain generators, as is often the case, a fusion will ensure that motion at the level is stopped, potentially eliminating the low back pain.
• A second advantage of spinal fusion surgery is that it reduces post-decompressive deformity. Some patients develop post-laminectomy kyphosis, which is an abnormal alignment of the spine. This too can often lead to additional surgery. Similarly, a fusion can correct any deformity the patient had before surgery and ensure that the normal alignment of the spine is restored. This may reduce wear and tear (and need for future surgery) on the neighboring levels.
You may want to ask some questions before your treatment begins:
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