Spinal fusion is a surgical procedure is used to permanently join two or more vertebrae in the spine so that motion no longer available between them and to provide stability. Spinal fusion involves bone grafts or bone graft substitutes placed between the affected vertebral bones. Bone graft can be taken from the patient during the primary surgical procedure or harvested from other individuals. The graft material acts as a binding medium. Fusing the vertebrae maintains the normal disc space between vertebrae, and prevents further damage to the spinal cord and nerves.
Not everyone with low back pain will require surgery. But if the condition is one that requires surgery, rest assured that spinal fusion has a long history as a treatment option.
There are different methods of spinal fusion.
- Bone is taken from the pelvic bone or from a bone bank. The bone is used to make a bridge between vertebrae that are next to each other. This bone graft helps new bone grow.
- Metal implants are usually used to hold the vertebrae together until new bone grows between them.
- Broken vertebrae
- Deformities of the spine
- Spinal weakness or instability
- Herniated disk
- Chronic low back pain
Spine surgery uses signal incision method to remove the muscles to reveal the spine. The open method is more beneficial and scores over the minimally invasive technique in many ways:
- Increased Access to the spine a longer or larger cut aids in removal of bone or inter vertebral dises adequately leaving no chance for compressive elements to be left behind.
- Greater Visibilitythere is increased chance of the serves, rods or bone graft material to be placed properly since the cut is much bigger & aid’s visibility. This reduces risk of damage to nerves or surrounding structures.
The disc space may be approached differently by surgeons when replacing disc material with metal spaces, bone or plastic:
- Anterior lumbar interbody fusion (ALIF) – Short for anterior lumber interbody fusion. The incision is made in the abdomen.
- Posterior lumbar interbody fusion (PLIF) – Short for posterior lumbar interbody fusion – As the name suggests the incision is made in the back.
- Transforaminal lumbar interbody fusion (TLIF) – Short for transforaminal lumber interbody fusion – the vertebra is accessed at an angle by making an incision in the back next to the spine.
- Direct lateral interbody fusion (DLIF) – Short for direct lateral interbody fusion. As the name suggests the incision is made laterally i.e. on the side of the abdomen.
To expose the spine suitable for surgery, the incision is made in the back and the muscles moved to the side. The joints between the vertebrae are loosened by removing them and then are roughened up so that new bone may be produced.
The vertebrae fuse due to the formation of new bone eventually bridging the gaps. To aid and help the vertebra to fuse as well as hold it in place metal implants rods, screws, hooks or wires may be put.
Bone grafts is done to augment fusion. When it is obtained from the patient himself it is known as autogenous bone graft when it is obtained from a donor or a bone back it is known as allogenous. Bone used for bone graft is typically harvested from the pelvis.
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