NEUROSURGERY ARTICLES

SPINAL FUSION

Burak Ozgur, M.D.

The human spine is a wondrous creation. It combines a remarkably agile structure while maintaining a safe and secure canal for the spinal cord. However, surgical intervention is sometimes required as a result of trauma or age-related changes in the spine. Often that intervention is a decompression which is simply an operation to make room for the spinal cord and/or nerves. Other times the spine may demonstrate 'spinal instability'. Spinal instability is when the normal spinal movements show evidence of abnormal motion. For example, bones of the spine may rub or grind against one another. This can be one of the causes of back pain. Usually this happens from a combination of events all linked by age-related degeneration. The soft gelatinous disc can lose its height and elasticity with age and then the bones may get closer and closer together until they begin to rub. This can cause severe pain. These events can occur anywhere in the spine, especially in the lumbar or lower spine.

When non-operative measures such as physical therapy, rest, and pain management fail to improve symptoms, then a surgeon may need to intervene. Back pain can be one of the indications for a spinal fusion. An operation in order to achieve a spinal fusion usually requires spinal instrumentation. Titanium rods and screws may be surgically placed in order to maintain rigidity in a particular area of the spine. Instrumentation basically forms a rigid internal brace that holds everything in place until a bony fusion occurs. A bony fusion is when the patient's bone grows across an area where immobility is necessary. The bone in a fusion is its strongest component and should maintain the immobility for a lifetime. The fusion then eliminates the abnormal motion that caused the patient's back pain.

There are many reasons that back pain occurs, so a proper workup and diagnosis must be made prior to any surgical intervention. Additionally, there are multiple ways to achieve an instrumented fusion. In other words, a surgeon may approach the spine from the front, back, or side. It all depends on the patient's diagnosis, treatment plans, and the surgeon's skills and experience.

Minimally-invasive spine surgery techniques have advanced tremendously in the last few years. They have reached the point where most of the traditional operations that were performed through large, risky, and painful approaches can now be performed through smaller incisions. The minimally-invasive techniques result in less pain, less blood loss, shorter hospital stay, and a more rapid recovery. This is often followed by a quick return to work or school.

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