Published: 04/08/2014 - Updated: 07/04/2016
Author: Birgit Bastl
Spinal fusion is a very delicate operation that is used only in extreme situations to fix spinal discs. During the operation, the vertebrae are joined together with the aid of plates and screws in order to obtain the stability of the spine. A spinal fusion is recommended only in extreme cases such as a serious disorder or injury of the spine after a serious accident when a spinal fracture occurs.
After surgery, spinal mobility is limited in part or completely and the vertebrae lose their function as joints and remain rigid. With the breakdown of bone structures, or scoliosis caused by an accident, spinal fusion can give the spine stability again. It is worth mentioning that you cannot reverse the effects of this intervention to regain mobility, so it is only done when other non-invasive techniques cannot help.
When is surgery necessary?
A spinal fusion is effective for very serious disorders that cause great pain in the back and spine, a serious accident or injury, where it is necessary to restrict the movement of the vertebrae, a portion of or, indeed, the entire spine. The idea is to protect important parts, such as the spinal cord.
Prior to surgery, X-ray examination and various other studies are made in order to further stabilise the vertebral column, as in the case of fractures and cracks. Sometimes the affected vertebral disc is removed and then replaced with a prosthetic one. Note that this operation requires general anesthetic.
The pre-intervention tests are conducted earlier in the hospital, and the patient is already hospitalised one day before surgery. Blood tests and an x-ray are done, and often an MRI is also requested. For some patients an ECG is recommended. All these measures are necessary to avoid risks during and after surgery.
Invasive or minimally invasive spinal fusion
The method chosen depends on the degree of damage to the spine. Spinal fusion may be partial or complete. A spinal disc can be completely removed and replaced with a prosthetic one. The area will then lose its mobility and therefore this method has a permanent effect.
The intervertebral discs are the connections between the vertebrae that allow movement. They are fibrocartilaginous and flexible. The human body has 23 vertebral discs, and these correspond to 25% of the length of the spine.
Prostheses or implants are usually made of plastic or titanium, and screws and plates are commonly used to recover the desired stability. This method is considered invasive. The procedure can be performed from the front or through the back and is an expensive operation that should be performed by surgeons with great experience, since the mobility of the patient is at risk. A minimally invasive method is only suitable when no parts of bone must be removed. This technique is also very important and instruments should be handled with absolute precision.
Complications and side effects
Since this operation is permanent, the hardening of the intervertebral discs of the spine cannot be undone with a new intervention. Besides, the structures and nerves of the spine can be injured during the procedure and have effects on motor function and sensitivity of the patient. Even the internal organs can be injured.
As with any surgery, there is a risk for the cardiovascular system. The wound after surgery is also great, so this is prone to infection, plus the after effects of pain of the operation must be taken into account. Patient mobility is very limited after a spinal fusion operation, especially in the first eight weeks, which means a risk of thrombosis. The first days after the operation a catheter is used for removing urine when necessary.
Back pain can occur in the first period after surgery, because the patient can only lie down in certain positions, and often cannot sit down at all. Sometimes the pain remains for a long time due to scarring and post-operative trauma.
After this time, physiotherapy begins. This allows the spine to get used to the movement, including specific exercises and training of the muscles of the back. When they are strong again, preventing new lesions, the patient can have their quality of life significantly improved.
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