BackWords

Last week, I gave a brief introduction to spinal surgery, which can be viewed here. In this mini-series, I want to provide a brief overview of these procedures so viewers will have a basic understanding of what’s involved.

Of all of the procedures I want to review in this series, the spinal fusion is the one my viewers seem to be most interested in- likely because it has been around for some time, and many people coming to this site have either had one, know someone who has, or may be a candidate for one in the future.

Spinal fusion is used when an intravertebral disc has been so compromised, that the spinal segment (the combination of the two vertebra, linked by the disc between them) has been destabilized. This destabilization can be painful, as the associated structures of this segment can rub up against the nerve roots at that level- or alter the body mechanics at that level causing irritation to the facet joints (the small joints which articulate the spine.) So patients with this type of compromise can have back pain as well as radicular pain- like sciatica

Like most spinal surgeries, it is usually only considered when all other conservative options have been either tried or ruled out.

In this procedure, the surgeon will go to the spinal segment in question, and ‘clean up’ the area around the disc from debris which may be causing irritation as best as they are able. Then, either utilizing stabilizing hardware or a ‘glue’ made from the patients own bone (A small fragment of the patients bone is harvested, usually from the crest of their pelvic bone, which is crushed into a gravelly mixture.This mixture of live cells then ‘heals’ back into a solid structure) the affected segment is ‘fused’ into a neutral position, resulting in a reduction of pain. Below is an x-ray from a patient whose segments have been fused with hardware.

Recovery from this surgery varies in length depending upon the overall health of the patient, and their level of conditioning prior to the procedure. Most surgeons will tell their patients not to expect the full benefits, for up to a year.

I have a fair number of patients who have had spinal fusion, and many have done well with it. There are patients for whom this is the best option, but it does have its downsides, which can become a larger issue based upon the patients age, and their overall activity level. The two most notable from a mechanical standpoint are:

-A loss of flexibility at the level of the fused segment.

-Because each disc absorbs external stress and shock- the forces which would be absorbed by the fused segment are passed onto the adjacent discs, and may cause premature wear and tear on them.

Because of these two considerations, surgeons began to look at other options to help fix the pain associated with a damaged discs for patients who are more active and wish to maintain the highest level of flexibility. In the next part of this series, we will look at one of these options, the disc replacement.