| Spinal fusion is one of the most feared and | | | | programs, has helped spine surgeons interpret and |
| misunderstood surgical procedures for the spine. | | | | use these advances in technology to obtain better |
| Everyone has heard some kind of frightening story | | | | outcomes for patients. |
| about a distant family member who had back | | | | Who Needs a Spinal Fusion? |
| surgery and was never the same afterward. Many | | | | As with all surgeries, there are proper uses that will |
| patients think a spinal fusion will cause their spine to | | | | result in good outcomes for patients with spinal |
| become completely rigid, and they envision a future | | | | fusion. |
| of robot-like stiffness with the inability to bend their | | | | In patients where the spinal bones have begun to slip |
| backs or touch their toes, after surgery. Over the | | | | and cause pressure on the spinal nerves |
| past decade, spinal fusion has also had a less than | | | | (spondylolisthesis), this excessive movement may |
| bright reputation as a treatment for pain. Given the | | | | need to be stopped to prevent worsening of the |
| overall perception that fusion of the spine is a | | | | nerve pressure. During surgery, these patients will |
| delicate surgery with questionable outcomes, patients | | | | have the bone spurs and disc protrusions removed |
| are quite concerned about proceeding with a fusion. | | | | from around the nerve roots and spinal cord, which |
| This article will help to dispel many of the | | | | may destabilize the bones of the spine and cause the |
| misconceptions that surround this treatment and why | | | | bones to slip more. Inserting screws and rods in |
| it is important to understand the procedure, when it | | | | these bones will prevent the bones from slipping any |
| should be performed and who might benefit from a | | | | further after surgery and also may be used for |
| spinal fusion. | | | | correction of the original slippage. |
| What is Spinal Fusion? | | | | Use of screws and rods can also provide stability and |
| Spinal fusion is a surgical procedure designed to | | | | correction for patients with scoliosis. Scoliosis is the |
| provide stability to an area of the spine that has too | | | | bending of the spine in an abnormal direction. The |
| much movement or movement that causes pain, | | | | curve of the spine may increase with time or may be |
| tingling, numbness or weakness in the arm or leg. The | | | | painful as the curvature of the spine increases. If the |
| object of a spinal fusion is to connect the bones | | | | patient has a large curve or the curve is continuing to |
| (vertebrae) that were previously too mobile and | | | | get worse, screws and rods are used to correct the |
| form a connection of bone in the spine that is more | | | | position of the spine and prevent the curve from |
| rigid. | | | | worsening. |
| A History Lesson | | | | In patients with obvious bone destruction from |
| Orthopaedic surgeons have long applied casts to | | | | fracture, tumor or infection, stabilizing the bones with |
| broken bones to provide support to fractures and | | | | screws and rods will provide the support that is |
| allow the bones to heal. The addition of this external | | | | needed so the underlying disease can be addressed. |
| support keeps the bones from moving. Why is this | | | | The structure of the spine can be improved while the |
| important? When there is too much movement | | | | patient receives chemotherapy or radiation. By |
| between broken bones or bone fragments, the repair | | | | removing the tumor in the spine, the back pain |
| cells are prevented from being able to connect the | | | | related to an expanding tumor can be relieved and |
| bone fragments together, so their process of healing | | | | the patient can remain mobile, which helps to prevent |
| will stop. | | | | pneumonia and blood clots. Being ambulatory, while |
| As orthopaedic surgeons have progressed in the use | | | | receiving chemotherapy and radiation, also improves |
| of technology, plates and screws, called internal | | | | the patient's mood and outlook while coping with |
| fixation devices, are now applied to fractured bones. | | | | their disease. |
| These rigid internal fixation devices are stronger and | | | | Who is Not a Candidate for Spinal Fusion? |
| add more support to the fractured bone. Plates and | | | | Most patients with disc herniations or pinched nerves |
| screws have been able to replace bulky external | | | | will not need a spinal fusion. These conditions can be |
| casting in a large group of fracture types. | | | | treated with simpler procedures that allow the |
| The same treatment principles are used by the | | | | removal of pieces of discs or bone spurs that do not |
| orthopaedic spine surgeon . There was a time when | | | | increase the movement in the bones. |
| fusions were supported with external bracing. This | | | | The more difficult indication for spinal fusion is in the |
| external support, provided by casting or rigid bracing, | | | | patient with severe pain in the back. Degenerative |
| has now been replaced with internal rods and screws. | | | | disc disease is still the leading cause of back pain in |
| Using these internal supports provides stronger bone | | | | the United States, but back pain can have many |
| connections that decrease motion even more. As a | | | | underlying causes. One of the reasons that spinal |
| result, the number of successful fusions has | | | | fusion developed a bad reputation is that they were |
| increased. The internal support of the spine is | | | | performed as a remedy for back pain that did not |
| stronger, allowing patients to get up and out of bed | | | | respond to other forms of treatment. Older fusion |
| and walk the day of surgery and to return to their | | | | methods and inadequate diagnostic approaches left |
| usual activities in 6 weeks. This is a far cry from the | | | | surgeons with few options for treating these |
| days of original spinal fusions that were supported | | | | patients, so some patients were given fusions as a |
| with a cumbersome hard plastic brace or cast, leaving | | | | last attempt to improve their pain . Most patients |
| patients with limited mobility or bed rest for many | | | | with lower back pain and degenerative disc disease |
| months. | | | | will not need a spinal fusion. |
| Spine surgeons are now better able to determine | | | | What Can Be Expected From Spinal Fusion? |
| which patients will be helped with a spinal fusion. | | | | It is expected that most patients will be back to their |
| Advanced imaging studies, including MRI and bone | | | | usual state of health and activity at approximately |
| scans, as well as the use of diagnostic injections, help | | | | 6-8 weeks after their fusion surgery. Most patients |
| today's spine specialist more accurately diagnose | | | | will be pain-free after their spinal fusion. It is |
| patients whose conditions would benefit from spinal | | | | important to choose a well-trained surgeon to make |
| fusion. Advances in surgical techniques and | | | | educated decisions about your diagnosis and |
| components, including the development of better | | | | treatment. With the combination of the proper |
| screws and rods, also have greatly improved patient | | | | diagnosis and properly applied spinal fusion most |
| results. Improved diagnostic and surgical training, | | | | patients will have very good outcomes. |
| including advanced training in spine fellowship | | | | |