Julie Blanco |
One of the oldest and historically most common types of orthopedic surgeries, spinal fusion is aimed at stopping motion of the spine at a painful vertebrae level, thus reducing related pain. In a fusion, the surgeon grafts natural or synthetic bone to grow between and join two vertebrae thus forming one long bone segment.
Spinal fusion operations have come a long way since the 1960s, when spine instrumentation systems began to emerge for the treatment of scoliosis and spinal fractures. These systems became more sophisticated in the early 1980s with the introduction of pedicle screws, special spine plates and/or rods. For the first time, each individual vertebra could be stabilized and locked together, eliminating motion and dramatically improving the fusion rates.
Fusion success rates improved dramatically with spine fusion cages added to the disc space for further stabilization, the development of high tech screws and rods, and advancements in synthetic bone fusion products.
With time, orthopedic surgeons have also learned that the best location to perform a spinal fusion is in the intervertebral disc space, or the openings between vertebrae. Here is where a surgeon can insert a hollow fusion cage to act as a shim and support the disc space.
But first, he places a bone graft or synthetic material inside the fusion cage prior to insertion. Once in place, the cage provides support and stability after surgery, allowing the grafted material time to bind with and join the vertebrae above and below.
Placing a cage into the disc space is called a lumbar interbody fusion (LIF). It can be performed from the backside (a posterior interbody fusion, or PLIF), the front or anterior side (ALIF), sideways (XLIF), or with a posterior lateral approach (TLIF).
To determine if a fusion is successful, X-Rays and CT scans are obtained after surgery to evaluate the bone forming process.
As a further extension of the instrumented spine fusion operation, major spine reconstruction surgery usually involves more than one level of the spine and corrects a significant deformity. It is also employed to treat a severe spine fracture or tumor.
In revision spine surgery, a surgeon may remove an entire vertebrae with diseased segments and replace it with artificial devices. Only a limited number of qualified spine surgeons perform major spine reconstruction and revision spine operations because of the complexity and experience required.
