Stenosis Advisor

Helping Spinal Stenosis Sufferers

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Spinal Fusion Options

Spinal fusion has become a very common surgical procedure in the United States over the past 10 years. There are many diagnoses that range from fractures of the spine to severe degenerative disc disease that prevent patients from being able to stand or walk are best treated with a surgical remedy.

This article is intended to provide a basic review of the many spinal fusion options that are available. It is best to talk to a fellowship-trained spine surgeon who will be able to give you a complete picture of all of the devices available that are recognized for quality and reliability or to help you rule out those that are not recommended.

As the number of spinal fusions has increased, the variety of procedures and hardware alternatives that are available has also increased. It may be easier to understand why there are so many types of fusions if you consider how fractures need to be fixed with fusion. With broken bones, there is usually little question about the wisdom of providing casts or plates and screws to stabilize bones that need to be realigned or stabilized. Spinal fusion provides the same stability for the spine as is used for other fractured bones. What is a spinal fusion? Screws and rods in the spine are used to keep bones from moving as the bone graft that is placed allows the stabilized bones to form a connection across a previously mobile disc space. The growth of bone between 2 previously mobile bones is called fusion.

Standard fusion technique: Initially, fusion of the vertebral bones was done by laying bone graft between the bones, to provide a scaffolding across which the native bone cells could grow. As the patient s bone cells move across the bone graft, they are able to incorporate the bone graft into the patient s own bone structure, forming a complete connection called a fusion. Bone graft is of primary importance in allowing the vertebral bones to fuse across a previously mobile segment. Studies of patient s with fusions done with bone graft alone have shown a relatively good rate of incorporation when patients are placed in back braces for 3 months or more. Because of the inconvenience and discomfort of the bracing, pedicle screws and rods have been added to provide an internal support that obviates the need for external supports.Internal screws and rods have increased successful fusion rates, as well as allowed patients to become mobile quickly after the spinal fusion.

Interbody fusion cages: As the skill of the surgeon has grown when applying screws and rods to the spine, we have, in turn, looked for better ways to gain improved results. Now, we are able to put bone graft around the back of the spine, as well as into the disc spaces. With these improved grafting methods, we are able to safely access the lumbar disc from the back of the spine. Adding bone graft to the disc increases the surface area for healing and should improve the overall success rate of the spinal fusion. Interbody grafting can be done from several different approaches, as access to the disc space can be achieved from multiple directions.

XLIF: This acronym stands for extreme lateral interbody fusion. XLIF is a newer device designed to provide a carrier for bone graft and support to the disc space. It is placed through an incision on the patient s flank.By making an incision on the patient s side, the abdominal contents can be moved out of the way for a very good view of the spine. Unfortunately, there are some significant nerves in the front of the spine that are very sensitive to being moved.This type of access to the spine can lead to weakness in one leg because of the nerve sensitivity.At this time, there are no long-term studies that demonstrate that this procedure is a success.

AxiaLif: This is another fusion device that has received some attention, due to its being touted as the least invasive spine fusion .This device is placed across the lowest disc space by access from the front of the sacrum (a large, triangular bone at the base of the spine, wedged between the two hip bones). By placing instruments through a small incision near the rectum towards the spine, the disc is accessed through a series of cannulas (hollow surgical tubes) and drills. This allows the disc material to be removed from the disc space.After the disc material is removed, bone grafting can be put into the hole that is created. This disc space is then supported by a tapered screw placed into the bones. So far, this device has had minimal post-surgical study and is most likely best done in conjunction with standard screw and rod fusion techniques.

Flexible Rods: There has been some recent excitement around rod and screw systems that are so-called non-fusion fusion devices. This confusing name infers that, although the intent of the screws and rods is for the bones to not move, these devices are designed to allow some movement. As was discussed earlier in this article, fusion is the solid connection of bones that had previously moved. The idea of these flexible rods is to provide enough stability to allow the bones to fuse together, but not enough to change the forces in the spine. This is termed a soft-fusion .At this point, there is no concensus as to how much or how little support is needed to achieve this. It is known that current screw and rod systems provide enough support to allow a fusion to occur while providing complete immobility of the vertebrae. Other than this complete connection, the amount of support less than complete immobility has not been defined and at this point is still under investigation.

Disc Replacement: Disc replacement was developed as an alternative to fusion and is suggested for those discs that have ruptured, but in which the bone structure is still good. If only the disc has gone bad, removal of the disc leaves a space that we normally fill with bone graft to promote fusion in the neck or lower back. With the development of the disc replacement, the space that is left from disc removal can be filled with a device that allows motion, rather than fusion.This is a complete reversal in the approach to disc removal; from complete immobility to total mobility. Disc replacement is intended to maintain the motion in the spine. This reconstruction of the spine should maintain the forces across the discs in the spine to prevent the other discs from deteriorating any more rapidly than their normal degenerative process. Disc replacement in the lumbar spine has met with some success in well-selected patients. It has not been a panacea for all patients with low back pain or degenerative disc disease. Disc replacement in the cervical spine has had good success, as most neck fusions are done for bad discs with the bones being in good condition.

Improved training, including advanced specialty training in fellowship programs, as well as improved implants, has decreased most surgical procedure times to 2 hours or less.Historically, older techniques have been known to take 4-6 hours for just the operation. By decreasing operative times, surgeons have seen decreased complications from the anesthesia, as well as decreased risks of infection and blood loss. Most surgeries under 2 hours will not require a blood transfusion.

A well-informed patient, who understands the benefits and the risks of their surgery, can fully participate in the choices that need to be made about their surgery. If you have been told that you need a spine fusion, ask questions and do your research. It is appropriate to ask your surgeon about their experience performing spinal fusions, how many of the fusion procedures they perform, how long the operation will take and the likelihood of needing a blood transfusion. Selecting a well-qualified surgeon can help ensure the best outcome for you and the success of your spinal fusion.

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Back Pain Relief With Chiropractic

Free Back Pain Relief Guide and Videos

Lower Back Pain

Low back pain is a common health complication that at some point affects more than 80% of the population, making it second in commonality only to the common cold. Although most people are aware that the common cold is due to a viral infection, back pain is often a mystery to its sufferers. Your Fort Worth Chiropractor is an expert at solving the puzzle.

Anatomy

To understand back pain, it is helpful to understand the anatomy of the spine. The spinal bones or vertebrae of the lower back are comprised of posterior joints called facets that link vertebrae to one another and serve to dictate the motion of the spine. Inter-vertebral discs, comprised of dense cartilage, connect the bodies of the vertebrae. This dense cartilage covers the nucleus, a soft material in the center of the inter-vertebral discs. The discs act as shock absorbers and spacers between the vertebrae. Ligaments and muscles also link the vertebrae. The sacrum is a wedge-shaped bone at the bottom of the spine. It is joined to the two pelvic bones at the sacroiliac joint. The spinal cord is located between the facets of the vertebrae. The spinal nerves go out from the spine between the vertebrae.

Causes of Back Pain

In most cases, back pain comes about without a trauma, an accident, or a major injury prior to the onset. The cause of most back pain is the cumulative effects of awkward sitting posture, bad work habits, incorrect lifting, lack of proper exercise and other unhealthy lifestyle-related factors.

These cumulative factors cause stresses and imbalances on the spine and, therefore, people may injure their back simply by bending over to pick up a piece of paper. The spine was already compromised and just the simple act of bending was enough to set off the challenge. When this comes about, the surrounding back muscles go into spasm to protect the stressed or injured tissues of the back. Chiropractors are back pain specialists. Your Fort Worth Chiropractor can help you to get out of pain quickly.

Disc Problems & Sciatica

Increased pressure on the intervertebral discs and imbalances in the muscles around the spine can occur during and after prolonged sitting, specifically in a awkward position. Eventually the lower spine loses its ability to function normally during everyday stresses. In the end, the intervertebral disc develops small fissures, or cracks, letting the soft nucleus to protrude the disc outward. If the disc pushes on sensitive tissues, it creates the pain that is often referred to as a slipped disc. If the disc presses on the spinal nerve, a person can develop sciatica, which is defined as pain, tingling, numbness, and on occasion weakness in the lower extremities. Sometimes if the disc protrusion or herniation is large and the condition is not managed correctly, surgery is necessary to dispose of the herniated disc material. But, with the correct chiropractic adjustments and management, as well as postural exercises, most of these cases can healthfully mend. If you are experiencing any of the conditions defined above, it is essential for you to seek chiropractic attention.

Spondylosis

Increased erosion and weight-bearing stress on the spine occurs when there is repetitive injury to the discs, facet joints, and surrounding ligaments. Bone spurs are produced when the cartilage around the joints is unfavorably affected by stress that induces calcium to deposit in the tissues around the vertebrae. These spurs can compress adjacent nerves, blood vessels and soft tissue resulting in symptoms ranging from minor pain and numbness to gross sensory loss and muscular atrophy. This condition known as Spondylosis – is a form of arthritis that is likely to affect almost everyone at some point in life, as it is a common part of the aging process of the spine as well. However, determinants such as previous trauma, unhealthy lifestyle, and repetitive stress injury influence the time of onset in life. Regular chiropractic care and overall chiropractic management is extremely beneficial in slowing the aging process of the spine, as well as aiding Spondylosis sufferers in managing their condition. Your Fort Worth Chiropractor has assisted many Spondylosis sufferers.

Sacroiliac Problems

The sacroiliac joints are a general area of dysfunction or injury in the low back. These weight-bearing joints link the upper part of the body to the lower pelvic portion and are normally very strong and stable. Disturbances from falls, sports injuries, or the lifting of heavy objects can cause the joints to become unstable and change to an abnormal position. This condition is called a sacroiliac subluxation. Pregnancy can also cause this condition. Sacroiliac subluxation causes imbalances in the lower extremities giving a person a functional long and short leg. Those with this problem will feel pain particularly with prolonged standing and walking, or during or after physical activity. Many complain of lack of energy and exhaustion. Many times this imbalance can affect structures further up the spine and individuals can develop neck and shoulder pain, as well as headaches. Chiropractic adjustments establish the proper alignment of the joints and are extremely affective in eliminating sacroiliac problems. Ask your Fort Worth chiropractor how you can receive effective pain relief.

Spinal Subluxation

Subluxated or misaligned facets joints are a common disorder of the lower back, as well as the entire spine. Subluxations can exist on their own or in conjunction with disc problems and Spondylosis. Subluxations are not only painful, but they can restrict the nerves as they exit the foramen (or spaces) between the vertebrae, creating paraesthesia. Paraesthesia is a variation of sensation described as a tingling, burning or "funny feeling." Paraesthesia in the upper extremities more often than notoriginates from nerve problems in the neck, while paraesthesia in the lower extremities is most often associated with nerve dysfunctionin the lumbar region (lower back). Visceral problems such as asthma and gastric conditions can also belinked to, or complicated by, spinal subluxations and nerve compression. Subluxations are best eliminated by chiropractic adjustments.

Trauma

Damage such as a fall, car accident, or sports injury can produce over-stretching or tearing of the tissues of the spine and lower back and create extensive pain and immobility. In order to escape long term disability or the development of any of the conditions listed above, chiropractic adjustments and treatment at the onset of symptoms is vital. If you experience a trauma, call your chiropractor as soon as possible.

Scoliosis

Scoliosis is often associated with low back pain. Chiropractic care offers exceptional pain relief.

When it comes to the spine, chiropractors have more education and training than medical doctors. I can provides state of the art diagnosis and expert treatment for any of the above-mentioned dysfunctions of the spine and lower back.

Published by Stenosis Advisor

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