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The surgery is chosen to address and correct where that pain is coming from and to remove those structures or fuse and stabilize those structures so that there is no longer a reason for pain. And then the surgeon has to decide which techniques are the best in his hands – which has he been trained for, what he’s the most experienced with. Most surgeons who are, either orthopedic surgeons or neurosurgeons, doing a lot of spine surgery usually have multiple approaches that they can fit to the individual patient because of their body confirmation, because of prior surgery, either in the abdomen or in the back, it may persuade the surgeon to choose an alternative route to get the same outcome.
Spine fusion is a technique spine surgeons use to immobilize one segment of the spine to the next segment of the spine. It can be done in the cervical region, the thoracic or chest region, or most commonly really in the lumbar spine or low back area. And there are three main joints to the spine. The disc is actually a type of a joint, and then there are two smaller joints on the back side of the spine. And classically most fusions have been done from the back side of the spine, making sure those facet joints get fused as well as that whole segment. And there are two little arms that stick out from each vertebral body, those are called the transverse processes, and bone can be placed between those processes on the left down to the next level, on the right down to the next level or down to the pelvis if you are at the lowest level. And then that bone heals and immobilizes that segment so that you should no longer have pain from the motion of those joints, particularly the posterior joints. An interbody fusion can be done from multiple approaches – it can be done from the front, which is called an anterior spinal fusion or interbody fusion because you remove disc material, you put bone into that evacuated space and then the bone heals to the segment above and the segment below. And that’s an extremely strong fusion because of the mass of bone you can get in and also because the anterior column of the spine is the portion of the spine that takes the most stress eighty to ninety percent of the normal biomechanical situation. So that interbody fusion can be done from the front as I’ve described, from the side, from a posterior-lateral, which is kind of obliquely off the midline, or from almost directly off the midline on each side. When those fusions are done in the interspace as well as out on the sides posteriorly, that’s when we get the highest fusion rates.