Spinal Fusion

Allograft bone graft substitutes for spine fusion surgery

spine-health — Wed, 12 Dec 2007 00:21:05 -0800

The biological and biomechanical environment for spine fusion surgery varies in different parts of the spine. The key factors are:

Whether the spine fusion surgery is done in the cervical, thoracic or lumbar spine, and;
Whether the anterior (front) or posterior (back) spine is chosen as the intended fusion site.
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Anterior cervical decompression and spine fusion for spondylotic myelopathy

spine-health — Sun, 30 Dec 2007 09:40:19 -0800

Benefits of anterior decompression and spine fusion surgery

In the past, cervical laminectomy (removing the posterior aspects of the spinal canal) to decompress (relieve pressure on) the spinal cord had been the procedure of choice to treat spondylotic myelopathy resulting from cervical arthritis.

Anterior cervical decompression and spine fusion procedure

spine-health — Wed, 12 Dec 2007 00:21:10 -0800

The decompression and spine fusion surgery is performed with the patient in the supine position under general anesthesia. Usual requirements include adequate padding of bony and soft tissue structures. Sequential compression boots are applied to the patient's lower extremities to avoid development of blood clots during the operation.

Most spine surgeons prefer to use Somatosensory Evoked Potentials (SSEPs) or Motor Evoked Potentials (MEPs) to monitor spinal cord function during the surgery. However, this is not essential.

Anterior Lumbar Interbody Fusion (ALIF) Surgery

spine-health — Wed, 12 Dec 2007 00:03:18 -0800

Doctor Cloward first performed an anterior lumbar interbody fusion (ALIF) surgery in the 1950s for treatment of low back pain for degenerative spine conditions. The Cloward procedure did not gain immediate favor because of fairly high nonunion rates (30-40%). In the 1990s, however, there was a resurgence of popularity for anterior (from the front) lumbar interbody fusion surgery because of the advent of new threaded titanium cages that held the disc space better and allowed for a higher fusion rate.

Arrange for assistance at home and work

spine-health — Wed, 12 Dec 2007 00:21:08 -0800

Following a spine fusion your ability to do many activities will be limited. This can include normal daily activities and occupational duties. It is best to make arrangements before surgery to have these needs met.

The extent of the assistance you may need depends on many things:

Specific type of fusion surgery to be completed
Your age
Nerve function
Type of job
Amount of help you have at home
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Artificial Disc Replacement or Spinal Fusion: Which is Better for You?

spine-health — Wed, 12 Dec 2007 00:21:05 -0800

Back surgery options

At the hospital (one to two days) after spine fusion surgery

spine-health — Wed, 12 Dec 2007 00:21:08 -0800

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Bone graft for spine fusion

spine-health — Wed, 12 Dec 2007 00:03:18 -0800

Bone graft for spinal fusion surgeries may either be harvested from the patient (autologous bone) or from a cadaver (allograft bone).

Autologous bone is harvested from the patient's pelvic bone (iliac crest) and provides the spinal fusion with a calcium scaffolding for the new bone to grow on (conduction). In addition, autologous bone also contains bone-growing cells (osteoblasts) and bone-growing proteins (bone morphogenic proteins).

Bone graft options for spine fusion

spine-health — Wed, 12 Dec 2007 00:21:10 -0800

In spinal fusion surgery, the bone graft is the material that is used to form the bridge between two vertebral segments in the spine to obtain the fusion. Bone grafts can be divided into three main categories based on where they are obtained.

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Bone graft options for spine fusion surgery

spine-health — Wed, 12 Dec 2007 00:21:05 -0800

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Bone graft site pain and morbidity after spinal fusion

spine-health — Wed, 12 Dec 2007 00:21:05 -0800

Bone grafting is typically a part of spinal fusion surgery for symptomatic degenerative disc disease. The fusion is accomplished when the graft material placed between the two bones of a motion segment induces bony incorporation on both sides, and heals them together as one bone. This eliminates motion but also hopefully reduces the pain from that segment of the spine.

Bone Graft Substitutes for Lumbar Spine Fusion Surgery

spine-health — Wed, 12 Dec 2007 00:21:05 -0800

Bone graft for spine fusion

There is a lot of interest in the spine community to develop a bone graft substitute to use during lumbar spinal fusion surgery procedures. Bone graft substitutes would eliminate the need to harvest the patient’s own bone, thus potentially reducing the risk and pain associated with the procedure and hopefully leading to a more reliable result (e.g. higher fusion rates).

Bone graft substitutes for spinal fusion surgery - August 2003 update (Research article)

spine-health — Wed, 12 Dec 2007 00:21:05 -0800

Osteobiologics, or the science of promoting bone growth and maturation, is probably the fastest growing segment of orthopedics and spine surgery. After several years of research, there is still much interest in developing effective bone graft substitutes—with the hope that eventually the need to harvest bone graft from the patient (usually from the pelvis) during a spine fusion surgery will be eliminated.

Bone graft substitutes for spine fusion

spine-health — Wed, 12 Dec 2007 00:21:05 -0800

Types of bone graft substitutes for spine fusion

There are several different types of bone graft substitutes that are either currently available or are in various stages of development for use in spine fusion surgery.

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Bone void fillers for spine fusion

spine-health — Wed, 12 Dec 2007 00:21:05 -0800

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Comparing Spinal Fusion With Artificial Disc Replacement

spine-health — Wed, 12 Dec 2007 00:21:08 -0800

Michael Janssen, DO

Computerized Tomography (CT scan) with Myelogram

spine-health — Tue, 11 Dec 2007 21:16:21 -0800

When combined with a myelogram, a CT scan provides for excellent nerve detail. The myelogram adds some additional risk and expense to the CT scan but provides substantial information about the nerve roots.

A myelogram consists of injecting a radiographically opaque dye (dye that is picked up by x-ray) into the sac around the nerve roots, which in turn lights up the nerve roots.

Conclusions to bone growth stimulation for spine fusion

spine-health — Wed, 12 Dec 2007 00:21:06 -0800

Over the last 25 years, bone growth stimulation has been established as a cost-effective adjunct to improve the clinical success rate of spinal fusion surgery. Various studies have clearly demonstrated that the use of bone stimulation as an adjunct to spinal fusion in the “difficult to fuse” population significantly improves success rates.

Article continues below

Conclusions: bone graft substitutes for spine fusion

spine-health — Wed, 12 Dec 2007 00:21:05 -0800

The field of osteobiologics continues to expand rapidly, and significant advances have been made in the area of bone graft substitutes. The Food and Drug Administration has recently approved a number of new bone graft products and substantial resources are being invested to continue researching and testing alternatives.

Controversies about Spinal Fusion Surgery: allografts, autografts, and fusion levels

Ben Parr — Tue, 26 Aug 2008 09:06:48 -0700

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Electrical Stimulation for Spinal Fusion

spine-health — Wed, 12 Dec 2007 00:21:06 -0800

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Elements of a Spine Fusion

spine-health — Wed, 12 Dec 2007 00:21:10 -0800

Understanding spine fusion

The most common reason for performing a spinal fusion is low back pain caused by painful motion of the vertebrae. The goal of a spine fusion is to eliminate the motion at a painful motion segment, thus reducing the pain caused by the motion.

Evaluating artificial disc replacement surgery

spine-health — Wed, 12 Dec 2007 00:21:05 -0800

Lumbar artificial disc replacement, also called total disc replacement, is indicated for the treatment of painful lumbar discs. The facet joints, which are paired and in the back of the spine at each disc level, must have little or no arthritic changes in order for the disc to be treated with artificial disc replacement, to minimize the risk of potential postoperative pain due to continued painful facet joint motion.

Evaluating spinal fusion surgery

spine-health — Wed, 12 Dec 2007 00:21:05 -0800

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Exercise prior to spine fusion surgery

spine-health — Wed, 12 Dec 2007 00:21:08 -0800

Spine fusions are usually recommended because your ability to do daily activities is restricted.
Despite this, it is important that you remain as active as possible before surgery.
You should try to take daily walks or do other aerobic exercise.
Even a small bit of activity is better than no activity at all.
Your physician may even request that you attend physical therapy to enhance your level of conditioning prior to surgery.

External bone growth stimulation for spine fusion

spine-health — Wed, 12 Dec 2007 00:21:06 -0800

Unlike implantable Direct Current (DC) stimulation, external—or noninvasive—bone growth stimulation devices do not require surgical implantation. Rather, they are worn externally, either using:

Small, wafer-thin skin pads/electrodes that are placed directly over the fusion site and deliver Capacitive Coupling (CC) stimulation, or;
One or two treatment coil(s) delivering electromagnetic fields via Pulsed ElectroMagnetic Fields (PEMF’s), or Combined Magnetic Fields (CMF), placed into a brace or directly onto the skin.
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External Bone Growth Stimulators for Spine Fusion

spine-health — Wed, 12 Dec 2007 00:21:05 -0800

Devices used for bone growth after spine fusion

External bone growth stimulation devices are worn outside the skin and do not require surgical implantation or extraction. Typically, the device is worn after spine fusion either as:

Small, thin skin pads/electrodes that are placed directly over the fusion site and deliver a type of electrical stimulation called Capacitive Coupling (CC), or;
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Fusion surgery considerations

spine-health — Wed, 12 Dec 2007 00:03:13 -0800

In addition to the primary reasons for failed back surgery discussed on the prior page, there are several reasons why a spine fusion surgery might fail to alleviate a patient’s back pain.

How an electrical bone growth stimulator helps with spine fusion

spine-health — Wed, 12 Dec 2007 00:21:05 -0800

Electrical bone growth stimulators are a supplemental form of therapy to help enhance the body’s bone healing process … a process that is absolutely essential for the success of any type of spinal fusion surgery.

Indications for spinal fusion

spine-health — Wed, 12 Dec 2007 00:21:06 -0800

The biggest risk for spine fusion procedure is continued pain, meaning that the surgery did not substantially reduce or eliminate the patient’s pain. The number one reason this occurs is that the fused disc was improperly identified as the cause of the patient’s pain, so fusing the disc was unnecessary and irrelevant. This is why getting an accurate diagnosis is critical.

Interbody cages for spine fusion

spine-health — Wed, 12 Dec 2007 00:03:18 -0800

In September of 1996, the FDA approved anterior interbody cages for use in the disc space, providing a new technique that allows the spine to be fused with less morbidity (e.g. less post-operative discomfort) than in the past.

Internal bone growth stimulation for spine fusion

spine-health — Wed, 12 Dec 2007 00:21:06 -0800

How internal bone growth stimulation works

The internal or surgically implanted bone growth stimulator, utilizing direct current electrical stimulation, requires that the device cathode be placed directly at the spine fusion site and the generator be placed in a soft tissue pocket under the skin. The length of the device generator is as small as a half-dollar coin. Depending on how much soft tissue the patient has and/or how deep the generator (with batter pack) is implanted, most patients cannot feel or palpate the generator while under the skin.

Internal bone growth stimulators for spine fusion

spine-health — Wed, 12 Dec 2007 00:21:05 -0800

Implantation of bone growth stimulators for spine fusion

An internal bone growth stimulator is implanted at the time of the spinal fusion surgery. This device is quite small and is implanted in a soft pocket of tissue under the skin in the lower back to the side of spine. It delivers small electrical currents directly to the area in the spine where bone growth (the spine fusion) is to occur (see Figure 1).

Interspinous Process Spacers

spine-health — Wed, 12 Dec 2007 00:21:07 -0800

As seen in Figure 1 the spinous processes are located in the very back of the spinal column near the skin surface. In fact, by passing the hand down the center of the low back one is usually able to feel several small prominences. These are the spinous processes.

Is lumbar fusion surgery a reliable procedure?

spine-health — Wed, 12 Dec 2007 00:21:08 -0800

Peter Ullrich, MD

Maximize the Ability to Heal After Spine Fusion Surgery

spine-health — Wed, 12 Dec 2007 00:21:08 -0800

Healing after spine surgery

One of the risks of any spine fusion surgery is a lack of healing of the bone graft, which is known as a pseudarthrosis. There are a number of factors that can affect this outcome after spine fusion surgery. These can include:

Poor nutrition
Osteoporosis
Previous back surgery
Multiple level spine fusion surgery
Severe deformities
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Minimally invasive spine fusion systems

spine-health — Wed, 12 Dec 2007 00:21:06 -0800

Spinal fusion technologies

Much of the published minimally invasive spine surgery techniques today describe less invasive methods of performing a spinal fusion with pedicle screw instrumentation. This article will review the major developments in minimally invasive surgery systems for posterolateral fusion and pedicle screw fixation.

Minimally invasive spine surgery system considerations

spine-health — Wed, 12 Dec 2007 00:21:06 -0800

The types of systems discussed may be compared in terms of several known advantages and disadvantages that tend to accompany use of these types of minimally invasive spine fusion surgery systems. Each system has a number of unique benefits and limitations.

Modern Lumbar Spine Fusion Surgery

spine-health — Wed, 12 Dec 2007 00:21:07 -0800

Spinal fusion

Lumbar (lower) spine fusion surgery has progressed dramatically over the last ten to fifteen years. The newer spine fusion surgery techniques allow for improved fusion rates, shorter hospital stays, and a more active and rapid recovery period. Additionally, better diagnostic tools and better understanding of indications for a spine fusion are improving outcomes.

Modern Spine Fusion Techniques

spine-health — Wed, 12 Dec 2007 00:21:07 -0800

The two primary types of medical devices used in a spinal fusion surgery include pedicle screws and anterior interbody cages or spacers. When it has been determined that a spine fusion is appropriate, the surgical technique utilized may vary.

There are several types of spinal fusion, including:

Molecular Engineering and Emerging Technologies

spine-health — Wed, 12 Dec 2007 00:21:05 -0800

In 2002 the Food and Drug Administration (FDA) approved a form of bone morphogenic protein (BMP-2) for anterior lumbar interbody spinal fusion. The BMP product is called INFUSE™, and it is made by Medtronic Sofamor Danek.

Multilevel spinal fusion for lumbar degenerative disc disease

spine-health — Wed, 12 Dec 2007 00:21:07 -0800

Multilevel fusion as a primary treatment for low back pain from degenerated discs is a controversial topic in spine medicine. In certain instances, a two level spinal fusion may be an effective treatment for debilitating back pain from two degenerated lumbar discs. However, lumbar fusion of three or more levels of the low back as a primary treatment for back pain is rarely recommended, and many surgeons recommend against it in all cases of multilevel degenerative disc disease.

Multilevel Spinal Fusion: Surgery, Risks, and Recovery

Ben Parr — Fri, 22 Aug 2008 14:31:47 -0700

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Lumbar Fusion for DDD

New bone growth stimulation devices for spine fusion

spine-health — Wed, 12 Dec 2007 00:21:06 -0800

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Obtaining a solid spine fusion

spine-health — Wed, 12 Dec 2007 00:21:06 -0800

Once a correct diagnosis has been made and the patient has decided to proceed with spinal fusion surgery, then obtaining a solid fusion is the next focus. Pseudoarthrosis, which means lack of a solid fusion, is becoming a less common outcome of spinal fusion surgery thanks to modern instruments and surgical techniques. However, there are a number of fusion risks that can adversely create this outcome, including the patient’s own health and personal habits (host factors) and the technique of the spine surgeon.

One to four weeks after spine fusion surgery

spine-health — Wed, 12 Dec 2007 00:21:08 -0800

One of the risks of any surgery is infection. This occurs about 1% of the time. Some people, (e.g., diabetics), are more prone to infections.

Wound infections usually present at about 10 days after surgery. Some symptoms to look for include:

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One to Three Months Post-op After a Fusion Surgery

spine-health — Wed, 12 Dec 2007 00:21:08 -0800

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Pedicle Screws for Spine Fusion

spine-health — Wed, 12 Dec 2007 00:03:18 -0800

The pedicle screw, which is sometimes used as an adjunct to spinal fusion surgery, provides a means of gripping a spinal segment. The screws themselves do not fixate the spinal segment, but act as firm anchor points that can then be connected with a rod.

Posterior motion preservation spine surgery: alternative to spinal fusion

spine-health — Wed, 12 Dec 2007 00:21:07 -0800

Motion preservation

There are a wide variety of posterior motion preservation devices in various stages of development and clinical investigation. The intent of these devices is to provide a better treatment alternative than spine fusion for patients with pain and loss of function caused by specific back problems, such as lumbar spinal stenosis, facet pain, and degenerative disc disease.

Postoperative care for decompression/fusion surgery

spine-health — Wed, 12 Dec 2007 00:21:10 -0800

Immediately after the surgery, patients will experience some difficulty swallowing or a sore throat due to manipulation of the esophagus. This usually resolves within several days, but symptoms may persist to a troublesome degree.

The pain associated with the procedure is relatively minimal, as most of the exposure is obtained by dissecting tissue, not dividing it. Pain at the graft site (where bone graft is obtained from the hip) is more of a concern if iliac crest graft is utilized.

Postoperative care for spinal fusion surgery

spine-health — Wed, 12 Dec 2007 00:21:08 -0800

Spine fusion surgery recovery

More Spinal Fusion Info:

Modern Spinal Fusion

Lumbar Fusion for DDD

Preoperative preparation for spine fusion surgery

spine-health — Wed, 12 Dec 2007 00:21:08 -0800

Preparing for spine fusion surgery

Spinal fusion surgery is recommended for different indications, but the goal remains the same—to stop the motion at a painful motion segment. At times the spine fusion surgery is scheduled quickly and there is little time to prepare. More often, however, a spine fusion surgery is elective and there is time to plan.

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Prepare for blood loss

spine-health — Wed, 12 Dec 2007 00:21:08 -0800

Often the amount of blood that is lost is quite small, but excessive bleeding during a spine fusion is always a possibility.

Some medications can increase the amount of blood loss. The most common ones are aspirin and NSAIDs (such as ibuprofen, naprosen, voltaren, Relafen). These medications should be discontinued 10-14 days before surgery. If you are on coumadin (warfarin), you should consult your surgeon and your primary care physician as to when to stop the medication and how to manage the anticoagulation. Spinal surgery cannot be done safely if your blood does not clot.

Rehabilitation following lumbar fusion

spine-health — Wed, 12 Dec 2007 00:21:08 -0800

Staying active speeds recovery from fusion

Review of current minimally invasive spine fusion systems

spine-health — Wed, 12 Dec 2007 00:21:07 -0800

The following is a review of three types of minimally invasive systems currently used in the US for performing a spine fusion surgery with pedicle screw fixation.

Spinal Fusion Alternatives

spine-health — Wed, 12 Dec 2007 00:21:06 -0800

There are a couple of alternatives to spine fusion surgery that may be considered for patients with low back pain from lumbar degenerative disc disease. Currently, the main fusion alternatives include:

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Spinal Fusion References

spine-health — Wed, 12 Dec 2007 00:21:06 -0800

Dwyer AF,Yau AC, Jefcoat KW: Use of direct current in spine fusion. J Bone Surg (Am) 56:442, 1974.
Kahanovitz N, Pashos C: The role of implantable direct current electrical stimulation in the critical pathway for lumbar spinal fusion. J Care Management 6:2-8, 1996.
Baranowski TJ, Black J: “The Mechanism of Faradic Stimulation of Osteogenesis.” In: Mechanism Approaches to Interactions of Electrical and Electromagnetic Fields with Living Systems. Eds. M Blank and E Findl. New York: Plenum Press, 1987, p 399.
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Spinal fusion surgery for isthmic spondylolisthesis

spine-health — Wed, 12 Dec 2007 00:21:10 -0800

Spinal Fusion: A Quick History

Ben Parr — Tue, 22 Jul 2008 13:10:26 -0700

Fusion surgery for the treatment of lower back pain has been done since the early 1900’s. At that time, spine fusion procedures were done to limit the deformity created by tuberculosis infections, and it was found that not only did the fusion procedure limit the deformity, it also reduced the patient’s low back pain as well.

Spine fusion indications

spine-health — Wed, 12 Dec 2007 00:21:07 -0800

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Spine fusion instrumentation

spine-health — Wed, 12 Dec 2007 00:03:19 -0800

The role of spine fusion instrumentation is to provide additional spinal stability while helping the fusion set up.

Various forms of instrumentation (medical devices) have been developed with the goal of improving the rates of successful spinal fusion. Because bone tends to fuse more effectively in an environment where there is little motion, instrumentation helps the fusion set up by limiting the motion at the fused segment.

There are three primary types of spine surgery instrumentation: pedicle screws and anterior interbody cages, and posterior lumbar cages.

Spine Fusion Post-Operative Care

spine-health — Wed, 12 Dec 2007 00:21:07 -0800

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Spine fusion risks and complications

spine-health — Wed, 12 Dec 2007 00:21:07 -0800

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Spine fusion surgery: doctor responses to patient questions

spine-health — Wed, 12 Dec 2007 00:21:10 -0800

The doctor is in!

Peter Ullrich, MD

Techniques for success with spinal fusion surgery - patients' advice

spine-health — Wed, 12 Dec 2007 00:21:10 -0800

Patients share tips for success with spinal fusion surgery

In this section, patients share their insights on making spinal fusion surgery a good experience and achieving a successful outcome.

Theoretical possibilities with posterior motion preservation

spine-health — Wed, 12 Dec 2007 00:21:07 -0800

Combined technologies

Three months and after

spine-health — Wed, 12 Dec 2007 00:21:08 -0800

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