Spinal Fusion Surgery

Listed below is the step by step procedure of spinal fusion surgery:

1. What is Spinal Fusion Surgery?
2. Why is Spinal Fusion Surgery?
3. Pre-operative Preparation
4. Day Before Surgery
5. Procedure Day
6. Methods/Techniques of Spinal Fusion Surgery
7. Post Procedure
8. Risks and Complications

What is Spinal fusion Surgery?

Spinal fusion is a process which involves surgical joining of two or more vertebrae by orthopedic surgical method or neurosurgical technique. Supplementary bone tissue from the patient known as autograft or from a donor called as allograft or artificial bone substitutes can be used by the surgeon for this procedure.

Spinal fusion is also known as spondylodesis or spondylosyndesis. It is carried out for stopping the motion at a segment of vertebra which is painful. This helps in reducing the pain caused by the joint.

Why is Spinal fusion surgery Required?

The main objective of Spinal fusion surgery is to imitate the natural process of healing of broken bones. This can be achieved by connecting vertebrae in the spine and getting rid of the motion between these vertebrae. For treating following conditions, spinal fusion surgery is recommended:

• Weak or unstable spine as a result of tumors or infections
• Fracture
• Deformity
• Scoliosis
• Lumbar Spondylolisthesis (isthmic, degenerative, or postlaminectomy spondylolisthesis)
• Lumbar Degenerative Disc Disease
• Kyphosis
• Arthritis in the spine
• Spinal stenosis

Pre-operative Preparation

Prior to spinal fusion surgery, imaging tests such as X-ray of the low back for confirming the abnormality in the bones need to be carried out. Instability or deformity in the spine can be identified by such tests. Even though these tests give idea about presence of fracture, most of the times they can not demonstrate the real cause behind back pain. This needs to be analyzed by additional tests for an anatomic diagnosis.

Prior to few days of spinal fusion surgery, patients need to stop smoking if they smoke as, this habit could interfere with post surgical healing. Two weeks before surgery, medications that make blood clotting process difficult, are not allowed to be consumed. These medications include Aspirin, Ibuprofen, Naproxen and similar drugs causing difficulties in blood clotting. Patients suffering from heart diseases, diabetes or other problems need to continue maintaining follow up with their respective doctors. Alcohol consumption needs to stopped prior to the surgery. Patients need to inform the surgeon about other illness they are suffering from, such as fever, cold, and flu.

Day Before Surgery

A day before surgery, record of tests of the patient such as blood tests and X-rays need to be organized. This helps in avoiding complications during surgery. Patients need to refrain from any physical stress a day prior to surgery. Consuming food since one night prior to surgery is prohibited. Laxatives will be given in order to clear the bowels prior to surgery. This is important because during surgery, patient will be under effect of general anesthesia, which makes the digestive tract very lax. If there is any digested or undigested food in the digestive tract during surgery, it could be ejected in the form of stool or vomitus. This can create complications during surgery.

Procedure Day

Medications recommended by the surgeon can be consumed only. Patient needs to be there on time at the hospital. Patient is advised to report to the hospital well in advance for the surgery. Patient will be given a sterilized surgical gown to wear and will be taken to the operation theater. Once inside the operation theater, patient is made to lie down on their abdomen or the side in a way that the back can be clearly accessed during surgery.

Methods/Techniques of Spinal Fusion Surgery

Spinal fusion surgery is performed under general anesthesia. This makes the patient unconscious during the surgical process. Based on the location of the vertebra to be fused, type of technique issued during spinal fusion surgery. The process of spinal fusion is divided into following steps.

• Incision:
  

  An incision is made to get access to the vertebrae which needs to be fused. This incision is made at one of the three locations, viz. Neck or back, either side of the spine or in throat or abdomen of the patient. This helps in getting access to the surgeon from the suitable side.

• Bone graft preparation:
  

  For fusion of two vertebrae, bone grafts can be taken either from the body of the patients from the pelvis or from the bone bank. In cases where bone of the patient is used, an incision is made above pelvic bone of the patient. A small part of pelvic bone is removed and then incision is closed.

• Fusion:
  

  For permanent fusion of vertebrae, placement of bone graft material is carried out between the vertebrae. Rods, screws or metal plates can be used for holding the vertebrae together during healing of bone grafts. Synthetic substances can be used in some case by the surgeon instead of bone grafts. With the help of these synthetic substances, bone growth can be promoted and speed of fusion process can be increased. Various types of spinal fusion surgery options are available. Mostly used surgical methods are given herewith.

  1. Posterior lumbar interbody fusion (PLIF):
     

     In PLIF, surgery is carried out from the back side and involves removing the intervertebral disclying between the consecutive affected vertebrae. The back side of vertebral bones is trimmed as well. The space where initially the cartilage disc was present is now filled with a graft and fixed with nails or screws. The graft is biological in origin and synthesizes bone over a period between the vertebrae thus fusing them together.

  2. Anterior lumbar interbody fusion (ALIF):
     

     The process is same as described above. The only difference is that this procedure involves accessing the vertebral column from the front, i.e. from the chest cavity, whereas the former procedure involves accessing the vertebral column from the back.

  3. Posterolateral gutter fusion:
     

     A bone graft is surgically attached to the affected vertebrae from outside. It is held in place with screws and nails. The bone graft is taken from the patient's body itself. The graft grows eventually due to blood supply from adjacent blood vessels. This leads to fusion of the vertebrae.

  4. Anterior/posterior spinal fusion:
     

     For this procedure, anterior as well as posterior approach. This surgery is more time consuming due to dual procedures to be performed. The intervertebral disc is also removed and bone grafts from outside are also attached. This procedure provides a much higher level of stability to the vertebral column.

Post Procedure

Hospitalization of 4 to 5 days is required after spinal fusion surgery. Patients will be given pain medications for reducing pain and discomfort. These can be given by intravenous route. Patients will get training for walking, standing and sitting after surgery at the hospital. Log-rolling technique can be taught to these patients after getting out of the bed. This includes movement of body without twisting the spine. Nutritious diet can be given to these patients through intravenous route since they can not be able to eat for two to three days. Patients will be given instructions regarding post operative care at home after getting discharge from the hospital.

Based on the location and duration of surgery, discomfort may vary in patients. After going home, if patients experience any unusual symptoms, they need to report it to the surgeon. These symptoms can be redness, chills, swelling and tenderness.

Tests After Surgery

Following spinal fusion surgery, blood tests are required to be carried out. Since blood loss can be experienced during this surgery, hemoglobin content needs to be monitored for ensuring normal blood oxygen levels. Oxygen can be provided to the patients for making the breathing process comfortable. For tracking heart rate and rhythm post surgery, a heart monitor can be used.

Back brace

A back brace can be fitted in some patients for limiting the movement in the spine. A snug-fitting t-shirt or tank top under this brace help in making the skin around the brace more comfortable.

Therapy and Exercise

It is very essential to keep the spine aligned in correct manner. Safe ways to dress, stand, sit, walk and perform other activities can be taught by physical therapists to the patients post spine fusion surgery. Without adding excess stress on the back these activities can be performed which helps in preventing further complications.

Risks and Complications

Spinal fusion surgery involves following risks:

• Loss of blood
• Poor wound healing
• Blood vessel or nerve injury in and around the spine
• Medication reactions
• Blood clot formation

All these risks and complications can be treated immediately using corrective surgery or other modes of treatment. These should not deter the patient from undergoing the surgery.

Spinal fusion surgery helps a lot in improving pain, stiffness, immobility and other problems of the back. Prior to undergoing surgery, patients should gather all the possible information about the procedure. This helps them in getting an idea as to what will they be undergoing. It is also important to heed all of the surgeon's instructions to get the best out of your surgery.

More information related to Spine Surgery

1. Information on Spine Surgery
2. Information on Spinal Decompression Surgery
3. Information on Laser Spine Surgery
4. Information on Cervical Spine Surgery
5. Information on Laminectomy
6. Information on Lumbar Discectomy
7. Information on Lumbar Puncture
8. Information on Vertebroplasty