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Spinal Fusion Surgery

surgery imageOlumide A. Danisa, MD

“You need a spinal fusion.”

That short statement uttered by your spine surgeon is enough to bring one to tears or at least experience considerable anxiety.  Much has been said about spinal fusion surgery by media outlets and lay people:  “It doesn’t work.”  “You are worse off than before the surgery.”  “You might get paralyzed.”  “You will get hooked on pain killers.”  “Too many are being performed.”  Everyone has heard such rumors from friends, coworkers, family members or even perfect strangers.  The topic of spinal surgery and especially fusion surgery can at times stir up unnecessary fear, mistruths or even urban myths.  The key to understanding the need for spinal fusion rests with understanding the reasoning for performing such a procedure.

Spinal fusion surgery has been performed since the early 20th century. Its use was fairly limited in the early 1900s when it was originally used to treat painful deformities of the spine. The expanding use of spinal fusion surgery closely mirrors the mind boggling advances in medicine and surgery. Major breakthroughs have also been reached in the field of radiology, anesthesiology, and bone and nerve biology.  As we began to understand more about the human body, we also found out how and why certain disease conditions affected the body in general and the spine in particular.  With this rapidly growing knowledge, we became better equipped in treating in treating a variety of spinal conditions. It is estimated that about 300,000 spinal fusions are currently being performed annually in the United States.

Fusion, in its simplest definition, means to prevent motion across a joint or motion segment.  The spine as an entity is comprised of numerous motion segments along the vertebral column.  When it functions properly, it provides stability for the body, protects the nervous system, and it permits painless motion of the neck and trunk.  There are instances, however, where some motion is needed to be sacrificed in order to provide overall well being of the body.  In general, the need to fuse the spine is indicated in the following conditions:

1.  Trauma:  fracture and or dislocation of the spine

2.  Deformity: where there abnormal alignment or curvature of the spinal (scoliosis or kyphosis) column.

3.  Infection: which can cause instability, deformity, and pain in the spine?

4.  Instability:  where there is excessive painful motion of one or more spinal motion segments

5.  Degeneration:  this is the broadest indication where deformity, instability, or simply, pain can occur.

6. Salvage: seen in patients who have had previous surgery, especially failed previous fusion attempts

The common theme to all fusion surgery is that there has to be solid bone growth across one or more spinal motion segments.  Historically living bone was harvested directly from the patient.  Sources include the pelvis (iliac crest), ribs or from other bones from the body.  Early attempts at spinal fusion had significant failure rates, because of incomplete fusion or non fusion, named pseudoarthrosis.  As we learned more about bone biology, we found that fusion rates could be increased by adding immediate stabilization.  Spinal surgeons began placing metal hardware to stabilize the spine until adequate bone growth or fusion could be achieved.  In general, it usually takes six to 12 months to achieve a solid fusion.  When we now discuss fusion surgery, instrumentation is commonly used with bone placement.  Technology has further advanced this practice; we now have cadaveric bone, bone substitutes, bone graft expanders to minimize or avoid bone graft donor site pain.  Newer and even stronger light-weight metals are now used for instrumentation.  Surgical techniques have also evolved where spinal surgeons in many instances can use smaller minimally invasive (MIS) incisions to still perform complex operations.

Great improvements have been made in spinal fusion surgery over the past few decades.  The goals for fusion surgery have always been to provide a stable, functional spine, while minimizing pain.  There is no surgery without complications.  There is no surgery that can eradicate all pain.   You must also be aware of conditions which can limit the success of fusion surgery such as:  cigarette smoking, poorly controlled diabetes, chronic medical illness, or even certain medications.   As the patient, you must understand why you need fusion surgery and have reasonable expectations of your surgical results.  Therefore, as in most things, communication with your spinal surgeon is imperative.

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