Most important success factor in fusion surgery - Spinal Fusion Surgery in India

Spinal Fusion Surgery

Lumbar spinal fusion is a type of back surgery in which a bone graft is inserted in the spine so that the bones in a painful segment of the spine fuse together. The fusion aims to stop the motion at a vertebral segment, which should decrease the pain caused by the joint. After the surgery it will take several months (usually 3 to 6, but sometimes up to 18 months) before the fusion is set-up. This surgery has been improved over the last 10 to 15 years, allowing for better success rates, and shorter hospital stays and recovery time.

Indications and contraindications for spinal fusion
The vast majority of people with low back pain will not need fusion surgery and will be able to manage the pain primarily with physical therapy and conditioning. A fusion surgery may, however, be recommended for patients with:

• Low back pain caused by degenerative disc disease that limits the patient's ability to function (after non-surgical treatments, such as physical therapy and medication, have failed)
• Isthmic, degenerative or postlaminectomy spondylolisthesis
• A weak or unstable spine (caused by infections or tumors), fractures, or deformity (such as scoliosis)

Before beginning the main part of a spinal fusion procedure, your surgeon will need to gather material for a bone graft, which is used later on to join the targeted spinal bones together. Depending on individual circumstances and your surgeon’s preferences, this graft material can come from bone harvested from one of your own hips or ribs, from bone harvested from a special donor cadaver, or from artificial materials such as plastics or ceramics.

Once the graft material is ready, your surgeon will make an incision and create an opening that exposes the site of the fusion. Potential locations of this incision include your abdomen, your back and the side of your neck or torso. After exposing the site of procedure and removing the spinal disc that sits between your spinal bones, your surgeon can place the bone graft in one of several ways. First, he can place the graft material directly into the empty space left by the removed spinal disc. Alternatively, he can place the graft material inside a device called a spacer or cage, then insert this device into the gap between your spinal bones. Your surgeon can also lay the graft material over the rear surfaces of the targeted spinal bones.
All of these techniques will lead to fusion of your bones and incorporation of the graft material by triggering your body’s natural healing process. Frequently, bone grafts are held in position by metal rods or plates and screws during this healing period.

Spinal Fusion Uses

Problems in your spinal column that can lead to a need for spinal fusion include a form of bone slippage called spondylolisthesis, debilitating forms of abnormal spinal curvature or deformity, and mechanical spinal instability caused by problems such as accidents or injuries. Surgeries that can produce enough spinal instability to require fusion as a follow-up procedure include complete or partial removal of a damaged spinal disc (discectomy); removal of all or part of the section of spinal bone that forms the back of the spinal canal (laminectomy); and widening of the gaps in your spinal column that allow nerves to pass through from your spinal cord (foraminotomy).

Spinal Fusion Benefits

The rigidity and stability provided by spinal fusion can prevent dangerous degrees of spinal motion, ease pain and other symptoms associated with unwanted or excessive spinal motion, and help prevent damage in the soft tissues situated near your spine. In the vast majority of cases, these benefits are either permanent or remain for extremely extended periods of time.

Success rates for fusion

Fusion surgery success rates vary between 70% and 95%, and there are several factors that will impact the success rate of the surgery, including:

• Spine fusion for conditions that arise from gross instability (e.g. isthmic or degenerative spondylolisthesis) tends to be more successful than surgery done for pain alone (e.g. degenerative disc disease).
• Individuals with only one badly degenerated disc (especially L5-S1) but an otherwise a normal spine tend to fare better than those undergoing multilevel fusions. Fusion surgery is generally considered for one or possibly two levels, and multilevel fusions should be avoided except in cases of severe deformity.
• Individuals who have significant disc degeneration usually find more pain relief from a fusion than those with only minor degeneration on the MRI scan (e.g. still have a tall disc).

The most important success factor in fusion surgery is confirming that a patient's back pain is truly caused by degenerative disc disease, rather than some other condition. This is done by a combination of a careful review of the patient's history, a physical exam, and diagnostic tests (such as x-ray and MRI), and/or possibly a discogram.

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