Why Might I Need Minimally Invasive Spinal Fusion
You might need spinal fusion for a variety of medical conditions, including:
- Degenerative disc disease
- Break of your spinal column
- Infection of your spinal column
- Tumor in your spinal column
These conditions might be causing you significant back pain. Your healthcare provider may want to try other more conservative treatments first, such as pain medicines and physical therapy. If these dont work for you, minimally invasive spinal fusion may make sense. But spinal fusion cant help all types of back pain. Your healthcare provider will recommend it, only if the procedure might work for you.
Talk with your healthcare provider about the risks and benefits of a minimally invasive spinal fusion, instead of a traditional one.
Spondylolisthesis: A Quick Definition
Degenerative spondylolisthesis is a forward slip of a vertebra over another caused by degeneration and instability of facet joints, as well as the degeneration of ligaments and intervertebral discs. Most patients report symptoms similar to spinal stenosis, such as low back pain and pain that radiates down the leg.
See also, differentiating spondylosis and spondylitis from spondylolisthesis by the Advanced Spine Center and more about adhesive arachnoiditis.
Recovery From Lumbar Fusion Surgery
Recovering from lumbar fusion spine surgery can be a challenging process. Fortunately, your spine surgeon will provide you specific instructions that will help make the post-operative period a bit more comfortable. Even more importantly, your surgeons recommendations help protect the long-term success of your low back procedurethats why its so essential to follow your surgeons post-operative instructions.
This article describes what to expect after lumbar fusion surgery, from post-operative activity recommendations to the warning signs that warrant a call to your spine surgeon.
Before surgery, it is important to talk to your doctor and anesthesiologist about pain management.
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Who Needs Back Surgery
We are able to treat the vast majority of patients who are told they need Fusion with non-operative, precise orthobiologic injections rather than surgery. To see what that treatment looks like, watch my video below:
However, if you fail that more advanced approach and have a significant Degenerative Spondylolisthesis, you may need surgery. Hence, the importance of knowing what the high-quality evidence says about whether you also need a Fusion is critical.
The upshot? Based on the research, adding a Fusion in a patient who has symptomatic Degenerative Spondylolisthesis is more of a $20,000 plus tip for the surgeon and hospital than better treatment than Decompression alone. So if you have this problem and fail the best precise orthobiologic care, realize that if the surgeon recommends Fusion, it may be time for a second opinion.
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References:
Austevoll I, et al. Decompression with or without Fusion in Degenerative Lumbar Spondylolisthesis. N Engl J Med 2021 385:526-538, DOI: 10.1056/NEJMoa2100990
Inose H, Kato T, Yuasa M, Yamada T, Maehara H, Hirai T, Yoshii T, Kawabata S, Okawa A. Comparison of Decompression, Decompression Plus Fusion, and Decompression Plus Stabilization for Degenerative Spondylolisthesis: A Prospective, Randomized Study. Clin Spine Surg. 2018 Aug 31:E347-E352. doi: 10.1097/BSD.0000000000000659. PMID: 29877872 PMCID: PMC6072383.
Chris Centeno, MD
Candidacy For Spinal Fusion
Even if you have scoliosis or another one of the conditions a spinal fusion can treat, there are factors that can make this surgery less practical for you.
The success of your spinal fusion will be lowered if you:
Smoke- Smoking impairs your bodys ability to properly heal.
Have arthritis in your back-Your bones may not be able to fuse properly.
Are obese-Obesity increases risks of infection and can slow the healing process.
Talk to your doctor about risks that pertain to your lifestyle or preexisting conditions during your consultation.
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Why Do I Need This Procedure
There are a number of reasons your surgeon may recommend spinal fusion. This procedure is frequently used to treat
- One or more fractured vertebrae
- Spondylolisthesis
- Abnormal curvatures of the spine, such as scoliosis or kyphosis
- Protruding or degenerated discs
- Instability of the spine
Spinal fusion is typically recommended only after conservative treatment methods fail. Your surgeon will take a number of factors into consideration before making this recommendation, including the condition to be treated, your age, health and lifestyle and your anticipated level of activity following surgery. If you are considering spinal fusion, please discuss this treatment option thoroughly with your spinal care provider.
What Are The Possible Complications After A Procedure Of The Spine
Though the complication rate for back surgeries is relatively low, there is still potential for a variety of health issues. The following are some common complications to consider.
You may be less likely to experience specific complications based on your health condition. Talk to your doctor to learn about a list of complications that could be pertinent to you following a spinal surgery.
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Is Spinal Surgery Dangerous
The answer to the question, Is lower back surgery dangerous? is both yes and no. Every surgical procedure has risks, including spinal surgery. The nature of spinal surgery increases the risk of severe complications compared to other procedures. Spinal surgery happens at and around sensitive areas in the spine and spinal cord. The most significant risks you could face if an error occurs during surgery include paralysis or a spinal infection.
Despite the possibility of severe complications, the mortality rate for spinal surgeries is low. One study found a mortality rate of 0.13% out of 803,949 lumbar spine surgery patients. The rate of surgical complications is also low, with a 7.6% complication rate in a study of 3,475 patients. Your back surgery may deviate from standard risk levels, depending on your existing health conditions and the type of surgery youre having.
What Types Of Spine Problems Are Treated With Lumbar Spinal Fusion
- occurs when one vertebra slips forward over the one beneath it. A fusion procedure may be recommended to correct the slip and stabilize the spine, as motion can irritate spinal nerve roots and cause back and leg pain.
- develops over time and causes one or more intervertebral discs to shrink, which changes the structure and strength of the disc. Structurally, as disc height it reduced, spinal nerves can become compressed causing sciatic-like symptoms.
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Spinal Fusion Surgery Is A Last Resort
Before you commit to terminal fusion, research all your options. Fusion should be a last resort salvage operation, only after youve tried a number of conservative treatments and investigated the alternatives.
About 3Spine
3Spine is a new kind of healthcare company that vertically integrates the development, clinical research, and delivery of novel healthcare technology. The BalancedBack Total Joint Replacement is the technology platform developed by 3Spine as an alternative to fusion for the lumbar spine.
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Will I Need Additional Surgeries
As detailed above, the likelihood of needing additional surgery appears to be around 40 percent. Some would say, however, that this statistic is conservative, and I tend to agree. Most patients require a second and even third fusion due to accelerated degeneration of the spine and adjacent segment disease. And every time you have additional surgery, theres more scarring, more stiffness of the spine, and less overall pain relief.
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No Slippage No Fusion
Fusion should be considered for spinal stenosis only if a vertebra has slipped forward with respect to its neighbor, a condition called spondylolisthesis. “If you can’t see that on an x-ray and you have spinal stenosis, you should be having a laminectomy,” Dr. Atlas says. “If your doctor is recommending fusion even though you have no spondylolisthesis, get a second opinion.”
Be especially wary of “complex” fusions that involve more than two vertebra being joined with hardware. These increase the risks of the procedure. Dr. Atlas says that in older people who have a complex fusion instead of a simple laminectomy, the risk of death rises from around two or three deaths for every 1,000 procedures to 10 to 20 deaths per 1,000. That’s a significant jump.
Like any surgical procedure, spinal fusion comes with risks as well as potential benefits. Instead of rolling the dice with “last resort” surgery, make sure you know what’s causing the pain and whether fusion is a reasonable option.
Surgery For Spinal Stenosis
Spinal stenosis is a common problem in the aging spine. Stenosis means the space around the spinal cord has narrowed. Bulging discs and overgrowth of bone and ligaments can all contribute to the narrowing, which presses on the nerves and causes pain. In some cases, fusion can be part of the solution.
Here are the signs of stenosis:
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pain when standing that gets better when you sit down
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pain that gets worse when you lean back but decreases when you lean forward
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pain in the groin, buttocks, and upper thigh, but not radiating pain down the back of the legs.
If conservative measures such as pain relievers and physical therapy are not controlling the pain and it affects your ability to get around, surgery may be worth considering.
The most common procedure for stenosis is called laminectomy, which involves removing the bony plate on the back of a vertebra. This opens up more space for the spinal nerves. “It’s a simpler procedure that is just as effective but safer than fusion, with 80% to 90% relief of pain,” Dr. Atlas says.
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Posterior Lumbar Interbody Fusion Surgery
Lumbar fusion surgery is usually done to relieve the pressure off the nerve roots which may be causing sciatica pain. The procedure is usually reserved when all forms of conservative management have been tried and failed.
The vertebrae in the human spine are stacked upon each other with the intervening discs. The vertebrae form a central canal that provides a conduit for the spinal cord and its covering. Spinal nerve roots exit the spinal canal through intervertebral foramina at each level to supply the target region. The vertebral body lies in front of the spinal canal, whereas the lamina lies at the back.
X-ray of the lumbar spine showing PLIF surgery.
Causes Due to degenerative or traumatic conditions, the spinal nerves or the thecal sac contents may at times be compressed/irritated leading to radiating pain known as sciatica. In severe cases, the compression may also lead to weakness of the leg muscles or loss of sensation in the lower extremities. When the nonsurgical management of the lumbar radiculopathy fails, a posterior spinal fusion may help in alleviating the symptoms.
The degeneration of the disc and the facet joints in the spine may lead to back pain. A chronic back pain not amicable to nonsurgical management may be managed by lumbar fusion surgery.
The bone cage ensures to maintain the distance between the vertebrae after removal of the disc. The bone cage also helps relieve the pressure off the spinal nerve roots.
What Are The Risks Of Back Surgery
Back surgery can carry higher risks than some other types of surgery because it is done closer to the nervous system. The most serious of these risks include paralysis and infections.
Even with a successful surgery, the recovery time can be long. Depending on the type of surgery and your condition before the surgery, healing may take months. And you may lose some flexibility permanently.
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What Is Spinal Fusion
At each level of the spine, there is a disc space in the front and paired facet joints in the back. Working together, these structures define a motion segment . Back pain may result when injury or degenerative changes allow abnormal movement of the vertebrae to rub against one another, known as an unstable motion segment . Two vertebrae need to be fused to stop the motion at one segment. For example, an L4-L5 fusion is a one-level spinal fusion. A two-level fusion joins three vertebrae together and so on.
Bones can be fused together by using your bodys natural healing process, using bone from another place in your body , using bone from a bone bank , or with the aid of cage devices. For fusion to occur between two vertebrae, a bone graft is needed to serve as a bridge. The bone graft must be placed in a bed where the disc nucleus has been removed and the cortical bone drilled to expose the blood-rich cancellous bone inside . And lastly, the bone graft and vertebrae must be immobilized while the bone graft and bed heals and fuses. The fusion area is often immobilized and held together with metal plates, rods, screws, or cages. After surgery the body begins its natural healing process and new bone is formed. After 3 to 6 months, the bone graft should join the vertebrae above and below to form one solid piece of bone . With spinal instrumentation and fusion working together, new bone will grow around the metal implants similar to reinforced concrete.
Back Surgery: 7 Types Recovery Time Risks And Benefits For Pain
Every day millions of people across the United States experience back pain. If you are one of these people, this article will help you decide if back surgery is right for you by walking you through the different types of surgery offered, the recovery times, and the risks and benefits of each.
Most people who have experienced back pain for prolonged periods will have most likely tried various non-surgical procedures, physical therapy, medications, massages, etc. If these non-surgical treatments have not worked and youre still living in pain, its time to discuss back surgery.
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Main Types Of Back Surgery
Here are the 4 main types of back surgery. Under each of these surgery umbrellas, there are many variations to treat the individual patient.
- Laminectomy
- Vertebroplasty/ Kyphoplasty
1. Discectomy
A discectomy involves taking out material that is putting pressure on the spinal column or nerve root. The procedure involves removing the herniated portion of the intervertebral disc which is putting pressure on the nerve or spinal cord. Removing part of the disc that is putting pressure on your spine will help address pain, numbness, weakness, balance issues, or mobility problems.
A microdiscectomy is a minimally invasive version of the surgery where part of the nucleus pulposus is removed traditionally or with a laser through a smaller incision with a microscope. A percutaneous discectomy involves removing part of the disc using a laser or suction through a small incision and probe.
A discectomy can be performed on various parts of the spine. For instance, a lumbar discectomy is performed to remove the herniated portion of the lumbar disc .
A discectomy is performed to:
- Address leg and/or buttock pain caused by nerve compression from a herniated/ ruptured disc
- Treat leg weakness, numbness
- Relieve pressure on the spinal nerves or cord
2. Laminectomy
This compression and pressure on your nerve can be the source of your back and leg pain. Compressed nerve roots can be very painful, and relieving this pressure through surgery can improve function and cut pain.
3. Spinal Fusion
What Is A Spinal Fusion
A spinal fusion is a surgical procedure that focuses on reconnecting one or more vertebrae. The fusing of the vertebrae keeps them from moving out of place, which is a well-known cause of back pain and discomfort.
Spinal fusion surgery can help alleviate back pain because you will no longer be able to overstretch nerves, muscles, and ligaments afterward.
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L5 S1 Fusion: The Painful Truth You Need To Know
Your low back pain is crippling and has failed to respond to conservative treatments. Your doctor recommended an L5 S1 surgery. What is L5 S1 Fusion? What are the indications for L5 S1 Fusion? Is L5/S1 fusion major surgery? What is the success rate of fusion surgery? What are the complications? Are there regenerative alternative treatments? Lets dig in.
What Is Back Surgery
Back surgery aims to change the patient’s anatomy to provide a cure for various types of pain they may be feeling associated with the back and spine. Watch this video to learn about chronic back pain explained.
There are a wide number of symptoms and conditions that can cause back pain. Which is why there are various procedures you can undergo depending on your individual situation.
Its essential to consult your doctor regarding what pain you feel this will enable them to steer you towards the appropriate treatment and procedure available.
Back surgery of any type may seem daunting. But, with new technology we have available now, there are highly-effective, minimally invasive surgeries that can cure your pain and quicken your recovery.
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Could There Be Complications
Every surgery comes with some type of risk. These have been linked to this type of procedure:
- Bleeding
National Institute of Arthritis and Musculoskeletal and Skin Diseases: “Handout on Health: Back Pain.”
USCF Medical Center: “Spinal Fusion for Scoliosis.”
American Academy of Orthopaedic Surgeons: “Spinal Fusion.”
American Academy of Orthopaedic Surgeons: “Adult Spondylolisthesis in the Low Back.”
American Academy of Orthopaedic Surgeons: “Osteoporosis and Spinal Fractures.”
American Academy of Orthopaedic Surgeons: âFractures of the Thoracic and Lumbar Spine.â
National Institute of Arthritis and Musculoskeletal and Skin Diseases: âQuestions and Answers About Spinal Stenosis.â
Mayfield Clinic: âDegenerative disk disease .â
Mayfield Clinic: âSpinal fractures.â
National Institute of Arthritis and Musculoskeletal and Skin Diseases: âWhat Is Scoliosis?â
Cleveland Clinic: âSpondylolisthesis.â
How Do I Manage Pain During My Recovery
Pain associated with your back surgery may be a significant symptom during your recovery. You may know others who have thought long and hard about back surgery, got it, and complained even more about the pain they felt after.
This doesnt mean youll have pain after your surgery.
The success of your surgery and any discomfort you feel afterward is largely dependent on the type of back surgery you have and the level of care you receive.
The Deuk Spine Institute is a premier concierge spine surgery clinic and outpatient surgical center specializing in minimally-invasive surgical techniques and comprehensive spine treatments designed to cure back and neck pain.
After receiving surgery at Deuk Spine Institute, you will be up and walking within one hour of your procedure. Testimonials from patients confirm this, stating, I was very impressed. I walked out of the facility with my wife. Walked. That surprised me, I got home and I could remember things and think clearly and I was pain free…I dont have pain anymore. In two weeks you couldnt even see where the incision was.
For more information about Deuk Spine Institute and to begin your path towards living a pain-free life click here
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