Spine Fusion Surgery Treatment Options
What is Spine Fusion Surgery?
The spine is made up of vertebrae and disks held together by facet joints, capsules and ligaments. The spine may weaken from age, injury and genetics developing instability (abnormal movements), misalignment, pain and suffering. Spinal fusion surgery strengthens the spine by joining two or more vertebrae together with bone and instrumentation. This is usually done with screws and rods but can be done with clamps, hooks and/or wires. Spinal fusion surgery has become increasingly more common over the past 20 years due to widespread training and advances in surgical technology.
Spinal fusion is often recommended for diseases that cause severe back and leg pain not responsive to conservative treatments such as rest, brace, physical therapy and steroid injections. The most common indications for a spinal fusion are degenerative disk disease (wearing out of the disk), spondylolithesis (slippage of the spine), broken back (spinal fractures from falls or car accidents) and cancer.
What is Degenerative Disk Disease?
Degenerative Disk Disease is a worn out painful disk. Disks are made up of a tough outer shell called the annulus fibrosis and a soft spongy gel-like center called nucleus pulposus. Overtime disk may dry out, collapse and rip forming degenerated disk and annular tears leading to pain.
Spondylolisthesis is the slipping forward of one vertebra over another. The bones are no longer in alignment. The most common causes of spondylolithesis are fracture of pars interarticularis during the adolescent growth spurt (isthmic sponydlolithesis) and arthritis in later life (degenerative spondylolithsis). The slippage may lead to pain, numbness, tingling and weakness.
Is Spinal Fusion the Right Option?
Fusion surgery has become a common treatment for back pain, but the results have varied. Some studies report mediocre to dismal results from surgery. The exact reason is unknown, but it is believed this maybe from soft tissue and bone damage related to the surgery. Fusion surgery involved large skin incision, significant muscle retraction (which may lead to muscle damage, weakness and pain) and bone removal (which may increase spinal instability rather then improve it). This collateral tissue damage from the surgery may result in more pain, weakness, instability and scar tissue leading to future difficulties. This has led to research and development of new treatments for back pain.
One of the most exciting new spinal treatments is endoscopic spine surgery. Endoscopic spine surgery is done through a very small tube placed between back muscles to reduce muscle retraction and damage. A micro video camera is inserted to the damaged area to fix the spine under direct visualization. This was initially done to treat disk and facet disease but now is being used for fusion surgery. Endoscopic fusion or more appropriately Endoscopic Lumbar Interbody Fusion (ELIF) is a spinal fusion surgery done under direct endoscopic visualization. The endoscope provides visualization of the surgical site in the disk space not possible even with a microscope. Endoscopic fusion may be done as same day surgery. People may have less blood loss, less pain and faster recover and return to work then traditional open fusion surgery.