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Spinal fusion is a surgical procedure that’s performed to correct problems with the spinal vertebrae. The goal of a spinal fusion is to fuse together the affected portion of the vertebrae so that it can heal into a single, solid bone. The vertebrae is fused using a bone graft or a bone graft substitute which fuses with the natural bone over time.
Spinal fusion is performed to relieve chronic pain, decreased range of motion and other symptoms when more conservative approaches have not been effective. It’s often performed in patients with conditions like:
Spinal fusion is often performed following spinal surgery like foraminotomy or laminectomy which remove a portion of the spine in order to relieve nerve compression and its symptoms, or after disc removal.
Different techniques can be used to perform spinal fusion surgery depending on the condition being treated, the patient’s age and health, and other factors. In general, spinal fusion may be performed using open surgery techniques with large incisions or minimally-invasive methods with small incisions. The incision may be made through the abdomen or throat (anterior approach) or through the back (posterior approach). Once the treatment site is exposed, damaged areas are removed or treated and the graft is placed in position and secured. It can take several months for the graft to completely fuse with the bone.
Most patients remain in the hospital for several days following surgery. Physical therapy typically begins while the patient is still in the hospital and continues for months afterward to help the spine regain mobility and function. Pain medication will be provided during the initial stages of healing to relieve discomfort and a back brace may also be recommended to provide additional support and to relieve strain on the back while it heals.
Minimally-invasive spine surgery employ techniques that use very small incisions to perform some types of spine procedures like lumbar discectomy or cervical discectomy. The surgeon uses special technology and instruments designed to be used through small incisions. While traditional open spine surgery cuts through muscles and other tissues to access the spine, minimally-invasive approaches dilate or move the muscles and surrounding tissues without cutting through them. As a result, these techniques cause less tissue damage and less bleeding, and patients typically recover much more quickly and with less discomfort compared to recovery following open spine surgery.
Lumbar discectomy is performed to relieve chronic symptoms caused by nerve compression in the lower spine. During the procedure, a small incision is made in the lower back over the damaged area and the muscles of the back are gently separated. A tube-shaped device is inserted into the incision to create an opening for the surgical instruments. The source of compression is treated by removing all or part of a disc or removing bone spurs, and a spinal fusion procedure may be performed to stabilize the area. Once the procedure is complete, the incision is closed and a small bandage is applied.
That depends on the issue being treated and other factors. Not all spine surgeries can be performed using minimally-invasive techniques, and not every patient is a good candidate for minimally-invasive surgery. The decision of which approach to use will be made following an in-depth evaluation.
Discs are spongy structures located between each pair of spine bones (vertebrae) whose function is to provide cushioning against jolts and impacts and to promote flexibility and movement in the spine. Each disc is composed of a tough outer layer called the annulus fibrosus (literally “fibrous ring”) and a softer gel-like interior called the nucleus pulposus. It’s this central portion that provides cushioning against impacts and injuries from falls and other accidents, and even from the day-to-day jolts from walking and normal activities.
Normally, discs remain between the vertebrae. But sometimes, a disc can slip out of place and an edge or portion of the disc can extend beyond the edges of the bones, creating a bulge or herniation that can press on surrounding soft tissue and nerves, causing pain and other symptoms. In some cases, the movements of the spine can cause the disc to rupture or break open and a small amount of the interior gel-like substance will leak out, increasing irritation.
Discs often become herniated as the result of an injury like a fall or car accident that causes strain or compression in the spine, forcing the discs out of their normal positions. Disc herniation also occurs more commonly with age. As we get older, the discs lose some of their fluid content, becoming stiffer and thinner so they’re more likely to slip out of place. Wear and tear also take their toll. Other risk factors for developing herniated discs include:
Herniated discs may be treated with medications to relieve pain and inflammation, combined with hot and cold therapy, physical therapy, stretching exercises and additional support to the back while it heals. Cortisone injections in the area near the disc can also help by relieving swelling and inflammation. People who have disc herniations may also require surgery.