What is the spinal fusion?The medical term spinal fusion describes an operative spinal fusion. In this surgical procedure, two vertebrae are stiffened together.
Spinal fusion is considered an invasive form of therapy for certain forms of severe back pain and spinal column changes. Surgical stiffening of the spine is either partially or fully performed depending on the indication. The degree of stiffening causes the later mobility between the vertebrae. Because multiple vertebral bodies are connected by plates or screws during spondylodesis, they can no longer exercise their joint function.
When a spinal fusion is a very complex and large operation on the back. After the procedure, it is no longer possible to improve body statics. Due to the irreparable result, this form of therapy is often the last option for the patient to improve the symptoms. Therefore, in almost all cases, stiffening surgery is not performed until neither conservative treatment such as physiotherapy, manual therapy, muscle building or back exercises, nor other measures such as injections and medication, have been able to produce any acceptable improvement in symptoms.
Function, effect & goals
Spinal fusion is performed due to severe spinal disorders. In severe scoliosis or serious spinal injuries after an accident and in a strong degradation of bone structures, the stiffening can be used. Even with a vertebral fracture, the stiffening brings the vertebrae together again.
The spinal fusion ensures that the stability of the spine is maintained. In addition, important structures such as spinal cord and aorta are protected. The endangerment of internal organs can also be averted by stiffening. In this way not only pain disorders but also neurological deficits can be treated.
The operative stiffening of the spine always takes place under general anesthesia. Only if no implants need to be used, the spinal fusion can be performed minimally invasive. This method ensures that both skin and soft tissue are minimally damaged on entry. The use of special instruments is controlled by imaging during surgery.
The invasive surgical technique itself is performed from the back, with the back muscles pushed to the side. This approach allows the operator to reach the vertebral bodies that are to be stiffened. This titanium screws are used, which are connected to longitudinal bars. Bone removal is done when nerve roots are narrowed by the vertebrae. In order to maintain the bony stiffening, bone structures are placed on the so-called transverse processes. The required bone mass is taken from the posterior part of the iliac crest. In some patients, it is necessary for metal baskets to be introduced into the spinal space where the disc lies in association with bone. Both screws and rods ultimately cause the bones to grow together permanently. On a subsequent metal removal can largely be dispensed with.
The duration of the operation depends on the extent of the spinal fusion. If the duration of intervention with a minimally invasive blockage is sometimes less than one hour, long-term spinal fusion can last up to several hours. Nowadays, in over 95% of all cases, the goal of stiffening is achieved. Using state-of-the-art surgical techniques such as bone attachment and screw fixation, successful fusion of the vertebrae can almost always be ensured.
Risks, side effects & dangers
Since spinal fusion is in most cases a very large procedure, there are risks to the cardiovascular system on the one hand. On the other hand, about one percent of those operated have wound infection. Basically, complications rarely occur. Nevertheless, it can lead to nerve injuries, since in most cases, constricted nerve fibers must be exposed in the context of a stiffening.
Damage to the nerves in the spinal cord can have serious consequences: sensory disorders and impaired motor skills are possible. However, very rarely do the screws used affect the nerve roots. Nevertheless, if damage occurs, the nerve usually recovers completely after some time. Nevertheless, the minimum risk remains to develop a permanent foot or leg weakness. Excludes the risk of full body paralysis. It is almost impossible for patients to be wheelchair dependent after undergoing spinal fusion in the lower back.
It happens that the vertebrae do not grow together sufficiently. The screws can then relax and cause pain again. Heavy smokers are particularly affected by this complication. In addition, it is possible that during or after the stiffening implant damage such as material fractures arise. To correct these problems, the spine has to be operated again. Since the operated patients are not allowed to move sufficiently within the first eight weeks after the procedure, the risk for the formation of a thrombosis is increased. Also by the use of the necessary urethra urethra infection can occur during prolonged wearing time.
Following the operation, patients often complain of back pain. These are caused by the procedure itself, as tissue structures are injured. In addition, unpleasant wound healing pain. In a spondylodesis, the surgeon makes a very long incision. If the scar heals badly, adhesions or growths may occur. These can cause long-term discomfort. This is different in a minimally invasive procedure in which only small wounds occur.