According to the National Institute of Neurological Disorders, stroke, lower back pain, or neurological disorder afflicts nearly 80 percent of all adults at some point in their lives. Back pain is the primary cause of disability on a global scale.
“Neurosurgery is more than a science,” says board-certified neurosurgeon, Wilson Asfora, MD. “It’s an art which requires precision, technique, and skill mastery to perform lifesaving and life-improving procedures on patients who deserve a better quality of life.”
Spinal Fusion Techniques & Procedures
Among the most common treatments and procedures to relieve back pain and other pain caused by spinal injury is spine fusion. While not everyone with low back pain will need surgery, if the patient’s condition is chronic and debilitating, spinal fusion has a long history as a successful treatment option that improves the quality of life.
In spinal fusion, the surgeon permanently joins two or more spinal vertebrae. The joined vertebrae no longer have movement between them. As post-operative time passes, the fused vertebrae heal into a single solid bone.
The procedure involves the following:
- Roughening the bone between the adjacent vertebrae
- Placing a bone graft
- Replacing the disk material between the vertebrae (if required), using special material
- If degenerative disc disease is present, inserting metal spaces
The surgeon then installs rods and screws on the fused vertebrae to support the vertebrae with an internal cast.
Spinal fusion surgery, in comparison to less invasive implant techniques described below, has the benefits of better access to the spine for removal of damaged bone or discs. Spinal fusion surgery also offers greater visibility for placing the rods and screws and bone graft materials that stabilize the spinal bone.
Invasive Spinal Fusion Surgery Techniques
Access to the patient’s spine and replacement of disc material and spacers can be through incisions in the following locations:
- The back—Posterior Lumbar Interbody Fusion (PLIF) is the most common surgical approach. Most PLIFs are done on the lower spine’s lumbar region. A spinal implant restores the spacing between two vertebrae.
- The abdomen—In Anterior Lumbar Interbody Fusion (ALIF), the surgeon accesses the spine from the front, allowing direct access to the disc. The main advantage is that the surgeon can access the spine without moving or disrupting the nerves. However, a vascular surgeon must assist in moving the organs and blood vessels so that the disc can be exposed.
- The back next to the spine for access at an angle—With Transforaminal Lumbar Interbody Fusion (TLIF), the surgeon makes an incision in the patient’s back next to the spine across the vertebrae. The surgeon places bone grafts in the spaces to be fused and strengthens the spinal stability by uniting the vertebrae.
Minimally invasive, probe-assisted procedures are made possible with small incisions through the following locations:
- The side of the abdomen—Direct Lateral Interbody Fusion (DLIF) is a surgical procedure to treat leg or back pain resulting from degenerating discs. DLIF is minimally invasive. While the patient is under general anesthesia, the surgeon makes two small incisions in the patient’s side and inserts a probe. The goal of TLIF is to remove the damaged disc and implant a bone graft that will grow and fuse the affected vertebral bones.
- Between the belly button and the hip—Oblique Lateral Interbody Fusion (OLIF) corrects deformity and degenerative spinal conditions. The surgeon places a large bone graft on the vertebrae’s strongest part. The graft serves as a support for the spine.
- Through the sacrum—With Axial Lumbar Interbody Fusion (AxiaLIF), the surgeon reaches the disc with an incision near the tailbone. The surgeon removes the damaged portion of the disc and replaces it with bone graft material.
There are some potential risks to back surgery, as in any surgical procedure. They include:
- Complications due to anesthesia—Nausea, and vomiting could cause problems during and after surgery.
- Blood clots—The body’s natural reaction to surgery can cause blood clotting and the danger of a thrombus and resulting life-threatening outcomes.
- Undiagnosed medical conditions like heart disease or rare allergic reactions, including neurological problems or damage to soft tissue.
- Instrument malfunction—Robotic and technological assistance during minimally invasive surgery can fail due to both software and hardware problems.
- Device migration—Screws, plates, and rods implanted on the vertebrae could move and lead to complications and unforeseen after-effects.
- Loss of spinal curvature or reduction (and sometimes a slight gain) in height.
Most of the foregoing complications can be treated and solved as they occur but may require additional hospitalization or surgery.
The main advantage to back surgery for most patients is lessened pain, and most patients will be back on their feet living an active life again. A quality surgeon advises every patient about the risks and how the patient can help ensure the best possible outcome following back surgery.
Recovering from Back Surgery
Patients who undergo back surgery can improve healing and recovery by observing the following:
- Stop Smoking—Smoking causes degeneration of the spine.
- Create a sensible, supervised exercise plan with a physical therapist—Losing weight will reduce stress on the spine. Exercise will help patients drop their tobacco habit.
- Walk often during back surgery recovery, unless advised otherwise by your doctor. Get moving as quickly as you can. Do an indoor route at first, and don’t bend lift, twist, stoop, or squat.
- Eat well—Avoid sugar and processed carbohydrates that increase inflammation. Drink lots of water.
- Make the home more friendly to recovery by reducing clutter. Pay special attention to the bathroom safety and sleeping arrangements.
- Be alert for incision wound discoloration or inflammation. If anything doesn’t look right, contact the caregiver.
Surgery of the spine continues to provide relief, mobility, and even life-saving assistance, and top surgeons are refining techniques, developing new technology, and improving outcomes every year. With advancements in spinal fusion and other methods for repair, the recovery and enhanced mobility of such surgeries is improving the lives of hundreds of thousands each year.