Spinal fusion is a surgery in which two or more vertebrae in the vertebral column or back are fused or joined to treat a slew of spinal problems and diseases, which cause debilitating back pain. This surgery helps to remove bone and tissue that are narrowing the spinal canal, squeezing the spinal cord and nerves, reducing pain and improving function.

There are many different causes of back pain like injury, poor posture, age, osteoarthritis, herniation of disc between two vertebrae, degenerative disc disease, narrowing of spine called stenosis, and spondylosis or lessening of space between the vertebrae- most of these can be treated using spinal fusion.

All of these causes put tremendous pressure on the vertebrae and pinch spinal nerves that pass through the back and radiate out into the arms, legs and torso. Apart from the pain, patients experience nerve and muscle weakness and irreversible damage affecting normal life.

Spinal fusion started off as just a treatment for fractures but now it has become the surgery of choice for a number of spine problems. Though it can be done anywhere in the spine, it is very effective when done in the lower part of the spine called lumbar spinal fusion or arthrodesis.

Spinal fusion is done by forming a direct bony connection between the vertebrae surrounding the painful discs, the cushioning between the vertebrae. Pain is stopped by stopping the motion of the painful discs.

There are different methods of spinal fusion each with its own advantages and limitations.

Techniques include fusion approached from the front, the back, or both of the vertebral column. Sometimes surgeons decide to use intervertebral cages or metal screws to provide internal structural support while the bone fuses. These cages may be placed between the vertebrae and packed with bone graft material taken from the patient or constructed out of synthetic materials.

What to expect?
Spinal fusion is not a risk-free procedure. It is a major surgery lasting several hours and carrying a number of risks like-

Failure of the vertebral fusion and breaking of metal implants
The vertebrae above and below the fusion can wear away aggravating problems
Blood clots may be formed that can travel to lungs causing embolism
Injury to spinal nerves causing permanent weakness in legs and problem with bladder and bowel function
Infections and blood loss
Heart attack or stroke during surgery
The patient has to be kept in hospital for a couple of days for post-operative care after which he will have to undergo rehabilitation for months. Hence, one should really think before going for spinal fusion. And when it is recommended, seek a second opinion before making a decision. 

Spinal Fusion Surgery - What To Expect?

Disc prolapse   or what is popularly known as a herniated disc   occurs when the soft, rubbery tissues of the spinal discs push through a crack in the tougher exterior casing. It usually results from wear and tear of the spinal discs over time.

Risk Factors-
The following factors may put you at risk of a disc prolapse  
  Genetics   You may have a tendency towards developing a disc prolapse
  Occupation   People who are engaged in physically demanding jobs are more likely to develop back pain
  Weight   Excessive body weight puts pressure on the discs in the lower back

Signs to Watch Out for-
Signs and symptoms of disc prolapsed may include the following  
  Pain in the legs, particularly in the calf, thigh, and buttocks
  Pain in the arms and shoulder that intensify when you sneeze, cough, or even move your spine into certain positions
  Tingling or numbness in the affected areas
  Muscle weakness
  Inability to hold an object

If the pain deteriorates i.e. if the pain shoots down from your back or neck to the extremities, consult a doctor immediately.

Acupuncture for Disc Prolapse-
Although there are certain non-surgical and surgical treatment methods, many healthcare professionals and doctors nowadays recommend acupuncture as an alternative cure.

Acupuncture is an ancient Chinese practice that believes that people possess  Chi  or an energy force. When the force is unbalanced or blocked, your body becomes susceptible to illness and pain. Traditional acupuncturists strive to free up these energy channels (known as meridians) by inserting needles into specific points in your body. It activates the release of endorphins in your blood, which acts as natural pain relievers and reduces pain.
The process involves inserting multiple needles, depending on your diagnosis. Most people do not feel pain when the needles are inserted. In fact, they feel relaxed or energized. The acupuncturist will leave the needles in for about 20-40 minutes   this may cause temporary soreness but do not pose serious complications.
Acupuncture can help relieve pain associated with bulging, herniated disc. If you are considering this option, you should visit a complementary and alternative medicine practitioner.

Disc Prolapse - Know How Acupunture Can Help!

Spinal fractures are extremely painful and usually happen when an external force applied to the spine exceeds the vertebral column s ability to bear the load. Many times, the bone fragments pinch and damage the spinal cord, which leads to an injury or dislocation of the bony vertebra. Although spinal fractures can develop anywhere along the spine, the most common site is the lower back.

What causes spinal fractures?

Spinal fractures can occur due to both minor trauma/falls and major accidents. The following are the probable causes of such fractures-

  Injuries sustained while playing a sport
  A traumatic injury
  Spinal instability
  Injuries sustained after falling from a height
  A whiplash
  Injuries sustained in an accident
  An underlying condition such as Osteoporosis, which causes the spinal bones to weaken

Symptoms observed:

Spinal fractures are characterized by the following symptoms-

  Muscle spasm and swelling
  Numbness
  Acute pain that worsens when you walk or stand for a long time
  A tingling sensation
  Restricted mobility of the spinal column
  Spinal deformity/disability
  Sudden onset of pain in the lower back region

What are the various types of spinal fractures?

Spinal fractures primarily fall into four categories, namely the following-

  Compression - Compression fractures are quite common in people with osteoporosis or bone cancer. The bones become fragile and brittle. If sudden force is applied with extreme pressure, the vertebra may not be able to support the load and that may result in a fracture.

  Burst - Severe trauma, such as a car accident can cause burst fractures. The external pressure is so much that the vertebra gets crushed. As a result, the bony fragments spread out and cause spinal cord injury. Unlike a compression fracture, where only a part of the vertebra is damaged, a burst fracture leads to multiple fractures in the vertebra.

  Flexion-distraction - This type of fracture is likely to happen if you are involved in a car accident. Normally, the spine is made to flex forward. However, a sudden jerk that pushes your body forward can put a lot of pressure on the spine and cause the vertebrae to break.

  Fracture-dislocation - This debilitating condition results from a torn ligament and broken bone.

What is the treatment for spinal fractures?

Treatment options for spinal fractures include both non-surgical and surgical methods.

  Non-surgical treatment - Most cases of spinal fractures can be treated with immobilization in a corset or brace for up to 10-12 weeks. Bracing will help prevent deformity and reduce pain.

  Surgical treatment - The doctor may recommend surgery in severe cases. The two standard surgical procedures are-

Vertebroplasty - The surgeon will insert a tube, known as a catheter, into the compressed vertebra. Through the catheter, he/she will inject bone cement into the fracture site. This will harden and stabilize the vertebral column. Vertebroplasty has proved to be an effective procedure to reduce pain. The surgery restores mobility and prevents loss of bone due to bed rest.

Kyphoplasty - During this procedure, the surgeon inserts a catheter into the spinal column under the guidance of an X-ray. Next, he/she makes small incisions along the back and inserts an inflatable bone stamp. The tamp, once inflated, bring back the vertebral body to its original height. It also creates a cavity to be filled with bone cement, which seals the cracks. The bone cement stops the vertebra from collapsing again. After the whole procedure, the surgeon will remove the catheter and stitch the incisions.

Following surgery, you will need to wear a brace for about 6-12 weeks. Physical therapy is strongly recommended initially to help you get back to your daily activities in a week or two.

Spinal Fractures - All You Should Know!

At some point in life most people experience acute pain in their lower back which is extremely painful. Pain in the spine causes a lot of discomfort and disruption in the life of an individual and hence, it is always better to get it checked on time. There are patients who even wonder when they should consult a neurosurgeon or a spine surgeon for their back pain. It is advisable that a physical examination is done by a primary care physician for low back pain before consulting a spine surgeon.

Why consult a Physical care Physician First?
The main reason to consult a primary care physician at first is that he would prescribe medications for severe lower back pain. The medications could include non-narcotic pain medications such as Ultram or non-steroidal anti-inflammatory drugs such as Motrin. The physician can even refer you to a chiropractor or for physical therapy to get relief from the back pain. Mechanical means are made use of by a chiropractor mainly to alleviate the back pain of the patient.

If the patient feels better with the physical therapy or the medications prescribed by the family doctor and is able to resume normal activities, then there is no need to see a spine surgeon. It is often recommended to take good care of the back and to exercise. A combination of ergonomics, regular stretching and improved everyday posture is beneficial as it reduces the chance of causing pain in the lower back. Exercise plays a very important role and it provides the possibility of reducing the pain.

Conservative Care for Treating Lower back Pain
It is best for patients to consult a conservative care specialist if after consulting a chiropractor they do not find any reduction in their pain and they do not want to undergo spine surgery. The conservative care specialists are well-trained in rehabilitation of musculoskeletal disorders and specialize in spine care. The role of the conservative care specialist is similar to a cardiologist who specializes in treating neurological disorders.

The specialist for spine care works along with the surgeon in a spine center to treat the lower back pain. The specialist is trained in diagnostic techniques and is capable of making use of a combination of diagnostic tests as well as injection techniques such as epidural steroid injections to diagnose the source of the lower back pain in a patient. They can even advise patients whether it is appropriate to consult a spine surgeon for surgery. Surgery is done to correct the anatomical conditions and it is performed only when non-surgical treatments are not successful in alleviating the pain of the patient.

When Is The Right Time To See A Spine Surgeon?

Spinal trauma, also referred to as spinal cord injury, occurs when a section of your spinal cord or the nerves at the edge of your spinal canal is damaged. The spinal cord acts as a messenger between the brain and other parts of your body. If the spine sustains an injury, all or some of these impulses may not get through. This may result in complete loss of mobility and sensation below the site of injury. An injury closer to the neck can cause paralysis throughout a larger part of the body than in the lower back region.

How do such injuries occur?

Often, spinal trauma or injury results from a violent event or an unpredictable accident. The following may severely damage your spinal cord-

  A violent attack (a gunshot or a stabbing)
  A motor vehicle accident that may cause trauma to the neck, back or head
  Falling from a great height
  Spinal or head injuries during some sports activity
  Electrical accidents

What are the signs of a spinal cord injury?

The followings signs and symptoms can be observed after an injury to the spinal cord-

  Difficulty walking
  Restricted movement of the legs and arms
  Stiffness, pressure and intense pain in the neck/back
  Loss of sensation
  Muscle spasms
  Loss of bowel or bladder control
  A twisted neck or back
  Lack of coordination, weakness or paralysis in any of the body part

When should you see a doctor?

If you experience significant trauma to the neck or head, accompanied by the above symptoms, then visit a doctor immediately. Spinal trauma or injuries is a debilitating condition and can deteriorate further if you do not seek medical intervention. In fact, if such an injury is not detected on time, you may have to face more severe complications. For instance, paralysis or numbness may develop immediately or gradually as blood clots and swelling occur in the surrounding region of the spine.

The doctor can detect spinal injuries using any of the following methods-

  CT Scan
  MRI
  X-ray

What is the treatment for spinal trauma?

An orthopaedic will recommend the correct treatment for spinal trauma or spinal cord injuries, depending on the severity of the condition.

  Medications - Intravenous medications can help reduce the pain and symptoms of acute spinal cord injury
  Immobilization - Braces, corsets, or neck collar can help realign and stabilize the spine
  Surgery - Surgery may be performed to remove bone fragments, herniated disks, foreign objects, or fractured vertebrae that are compressing the spine. Surgery also prevents deformity and pain in the long run.

Recovery starts typically within a week after the treatment. If you undergo surgery, you will have to wait a little longer to get back to your day-to-day activities. It is advisable that you follow up with your doctor and carry on physiotherapy for the first six months at least.

Spinal Trauma - When Should You Consult A Doctor?

Spine surgery is conventionally performed as  open surgery , which means the region being worked on is opened with a long entry point to permit the surgeon to view and access the area. Technical and scientific advances have permitted more back and neck conditions to be treated with a less obtrusive surgical technique. The minimal invasive spine surgery (MISS) does not include a long cut, and it prevents causing damage to the muscles around the spine. As a rule, this causes less pain after the surgery and a speedier and healthy recovery.

Spine surgery is normally suggested when non-surgical treatments like medicinal or exercise based methods have not helped in lessening the excruciating symptoms of your back problem. Moreover, surgery is just considered if your doctor can pinpoint the correct reason of your pain, for example, a herniated circle or spinal stenosis. 

MISS is also called less obtrusive spine surgery. In these procedures, surgeons utilise particular instruments to get to the spine through little cuts. The surgery process is as follows:

During the surgery, a little entry point is made and the tubular retractor is embedded through the skin.
It is also inserted into the delicate tissues down to the spinal cord.
This makes a passage to the little range where the problem exists in the spine.
The tubular retractor holds the muscles open and is set up all through the surgery.
The surgeon gets to the spine utilising the little instruments that fit through the focal point of the tubular retractor.
Any bone or disk material that is expelled goes out from the retractor.
Any gadgets needed for the fusion process, for example, screws or rods, are embedded through the retractor.
A few surgeries require more than one retractor.
Keeping in mind the end goal to see where to put the entry point and embed the retractor, the surgeon is guided by fluoroscopy.
This strategy shows ongoing X-ray pictures of the patient's spine on a screen throughout the surgery.
The surgeon additionally utilises a microscope to enlarge the view through the retractor.
Towards the end of the procedure, the tubular retractor is expelled and the muscles come back to their original position.
This restrains the muscle damage that is more ordinarily found in open surgeries.
It is very important to talk about these risks with your doctor before your surgery or procedure.

Infection: Antibiotics are consistently given to the patient some time before, during, and regularly after the surgery to reduce the danger of infections.
Bleeding: A specific measure of bleeding is normal; however, this is not commonly dangerous.
Pain in the grafted area: Some patients will encounter surgical pain at the bone joint site.
Recurring symptoms: A few patients may encounter a repeat of their side effects.
Pseudarthrosis: Patients who tend to smoke are more prone to pseudarthrosis. This is a condition wherein there is insufficient bone formation. In case that this happens, a minor surgery may be required.
Nerve damage: It is possible that the nerves or veins might be harmed during these operations. These complications are extremely uncommon.
Blood clots: Another complication is blood clots in the legs. This poses a threat because these clots can break off and settle in the lungs.

Minimally Invasive Spine Surgery - A Guide On What To Expect?

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