360 Back and Spine Center uses a conservative approach to the treatment of decompression, scoliosis, and other back and neck conditions. In partnership with our patients, we ensure they have the information they need to make informed decisions about treatment.
Spinal fusion is a very common surgery that treats a number of conditions. However, not everyone with pain will require this surgery.
History of Spinal Fusion
The surgery is by no means a new concept. However, the techniques used to complete it, as well as the conditions it treats, have evolved and expanded.
Spinal fusion surgery, originally introduced in the early 1900s, was initially done to correct spinal deformities that occurred as the result of tuberculosis infections. The surgeries performed for this purpose were found to be successful, not only because the surgery limited deformities in patients, but because it was also able to reduce the low back pain these patients suffered.
Spinal fusion in the 1900s saw bone being taken from the patient’s tibia. This bone was then broken into small fragments before being packed between affected vertebrae. Over time, the fragmented bone would ossify or harden like cement. When this happened, the affected segments would be immobilized.
After a decade of improvements, the procedure was improved upon, and, in 1929, was used to treat other degenerative conditions of the spine. The publication of a paper by two general surgeons in 1934 concluded that the most frequent cause of back pain and sciatica needing spinal rehab was due to nerve-root-compressive disc herniation, and not due to a disc tumor as was previously suspected.
The paper identified the origin of these herniations to be from the disc’s center. Finally, the paper identified that the best way to correct this type of herniation was via fusion.
It wouldn’t be until 1953 that the modern version of spinal fusion would be pioneered. This modern version saw the tissue being removed from affected vertebrae. The bony cortex is then removed via grinding, and this ground bone is placed between affected vertebrae, where it hardens into bone.
Today, the bone that is placed between vertebrae can be obtained via donation. Plastic or metal spacers may be needed if a certain condition dictates it.
Conditions That Spinal Fusion Treats
In its infancy, spinal fusion surgery was used to treat deformities as a result of tuberculosis, fractures, and other issues. Today, it is used to treat spinal stenosis and age-related spinal problems.
Spinal fusion surgery may also be done as a follow-up treatment to treatments completed for the purpose of treating tumors, infection, injury, disc herniation, and spinal stenosis.
Modern Spinal Fusion Surgery
Spinal fusion surgery involves accessing the spine from the front, the side, or the back. In all cases, the surgeon will take bone and use it to create a bridge between vertebrae. As well, the surgeon will likely insert metal implants, which will hold the vertebrae together until new bone has grown.
Anterior (Frontal) Lumbar Spinal Fusion
Also known as anterior lumbar interbody fusion, or ALIF, this process involves the patient lying on their back, and the surgeon accessing the spine via an incision in the abdomen. In order to access the spine, the surgeon must retract vascular and abdominal structures.
Once the spine is able to be accessed, the surgeon removes disc material and replaces it with bone graft material, as well as inserts spinal implants.
Posterior (Back) Transformational Lumbar Interbody Fusion
Transformational lumbar interbody fusion, also known as TLIF, requires the patient to lie on their stomach, and the surgeon accesses the spine via an incision in the back. In order to access the spine, the surgeon must retract nerve roots and muscles. Once the spine is in view, the disc material is removed and replaced by bone graft material and spinal implants.
Direct Lateral (Side) Interbody Fusion
Direct lateral interbody fusion, also known as DLIF, sees the patient lying on their side. The surgeon makes an incision into the side and forms a small passageway to the spine through the soft tissue and the psoas muscle.
In order to access the spine, the surgeon uses a real-time, fluoroscopic x-ray guide to insert tubular dilators which create this passageway and allow for the removal of disc material and the insertion of bone material and implants.
Hospital Stay and Recovery Time
Regardless of the way in which spinal fusion surgery is performed, the length of time that the patient will remain in the hospital will depend solely on what Texas spine institute surgeons and their patients decide in terms of postoperative treatment. However, a patient should expect to remain in the hospital for a few days for monitoring.
Once home, a patient may not necessarily require bed rest, although their doctor may recommend that they wear a back brace during their recovery. The total time for recovery after spinal fusion surgery can be extensive and require participating in swimming, stationary cycling, and walking to reclaim spinal mobility.
Risks and Success Rate for Spinal Fusion
There are risks involved with any surgical procedure. In the case of spinal fusion surgery, the overall health and age of the patient will determine the level of risk. In addition, the reason for surgery and the type of spinal fusion will also determine the risk level.
Patient risks include injury to the nerves, breakage of metal implants, surgery failure, pain at the site of the bone graft, infection, and rejection of the bone graft. There may also be risks not immediately evident due to a rare allergic reaction, undiagnosed heart and other diseases, blood clots, or risks which present themselves following anesthesia of the patient.
Depending on the severity of these occurrences, a longer stay in the hospital may be necessary. Regardless, a surgeon will inform the patient of all possible risks prior to surgery. Finally, the decision to undergo surgery is solely the patient’s.
Alternatives to Spinal Fusion
A patient who is experiencing low back pain due to degenerative lumbar disc disease, but who does not wish to undergo spinal or cervical fusion surgery, has four options: disc regeneration, posterior dynamic stabilization, disc replacement, and annuloplasty.
Although still being tested as a treatment, disc regeneration is showing much promise. This process involves the use of gene therapy to stimulate disc regeneration or to slow the rate of disc degeneration.
In addition to the above, research continues into the inhibiting of disc degeneration via gene therapy. Research into gene therapy for the treatment of intervertebral discs is still in its early stages.
Posterior Dynamic Stabilization
The aim of posterior dynamic stabilization is to preserve spinal motion while relieving pressure on affected discs. Several systems are available to achieve this stabilization. Each one acts as an internal brace to allow controlled movement in the affected area. Systems utilize screws, cords, spacers, and rods of different levels of flexibility and moving parts.
The disc replacement process involves the removal of the affected disc, which is then replaced by an artificial disc. The goal of disc replacement surgery is to preserve normal spine motion, which is thought to reduce the risk of degeneration for other segments in the lumbar spine. As well, greater pain reduction may be possible with disc replacement than with spinal fusion.
Also known as intradiscal electrothermal coagulation (IDET), this procedure involves the insertion of a needle into the space between affected discs, through which a catheter is passed. The catheter heats up the outer core of the disc space to relieve pain. The procedure cauterizes nerve endings, which South Texas spinal clinics suspect makes them less sensitive.
This procedure is minimally invasive and usually is performed on an outpatient basis. Mild sedation and a local anesthetic are required as part of the surgery.
Some of the above procedures are still in their infancy, in terms of research and testing, while others are no longer preferred by spinal specialists. This is why consultation with a spinal specialist is so important; they can offer advice and information on current procedures.
Getting Professional Advice About Spinal Fusion and Alternatives
If your condition requires the assistance of a professional to treat and correct it, the best option is a location that is dedicated to presenting patients with all of their options. 360 Back and Spine Center specialists help patients with herniated discs, spinal deformities, and other conditions by suggesting a range of comprehensive treatments, including non-invasive options. Learn more about the benefits of Frisco spinal rehab by contacting 360 Back and Spine Center: (682) 808-4389.