Spine Surgery & Implants

What is Spine fusion ?

Fusion in the spine means to stop the movement between two vertebrae by adding Implants and bone graft. The movement, so-called instability scientifically may be due to degeneration, trauma, and infections. The decision as to the appropriate surgical approach to a particular patient’s problem requires careful evaluation by a spine specialist. There are numerous ways to perform a spinal fusion and each of these techniques has advantages and disadvantages, which need to be carefully understood by the patient undergoing the procedure.

Why do we use Implants (screws, rods and cages). Is this really necessary? Will they harm me in any way ?

Historically, spinal fusion has been performed with a bone graft without implants. However, the fusion rate with this technique is notoriously low, in the 50% range. The clinical result of spinal fusion without implants is also not very good. In addition, patients treated in this manner are often immobilized with prolonged bracing and/or bed rest for weeks or months.

Modern techniques utilizing pedicle screw fixation with plates or rods in combination with devices replacing the disc have resulted in fusion rates of well more than 95% and associated increases in clinical results to around 70-80%. Thus, the use of implants is not necessary, but certainly an advantage in terms of rapid rehabilitation to the patient and better clinical results with higher fusion rates.

The implants are made out of titanium and will not harm you in any way.

Does it matter what screws and rods my surgeon uses? Do you have a choice ?

All of the spinal implants manufactured or marketed by various companies are of extremely high quality. The difference between various implants is more important to the individual surgeon in terms of his familiarity with their particular surgical techniques rather than specifically providing the patient with specific advantages. The use of titanium rather than stainless steel does have certain advantages in terms of better imaging with MRI scanning. It is certainly reasonable for a patient to ask the surgeon the rationale of using a particular implant for their surgery.

If you fuse my spine, will be spine mobility decrease ?

Ninety-five percent of all the bending, in terms of being able to touch your hands to the ground or your toes, involves your hip joints, not your spine. Thus, patients undergoing a one or two-level fusion typically have no loss of ability to touch their toes. If more than two levels of the spine are fused, there is some permanent loss of motion, but, again, more than 95% of all the flexion occurs at the hip joints, not the spine. Stretching the muscles about the pelvis and hips cannot be over emphasized.

How long will I be admitted in the hospital ?

Hospitalization for spine patients usually lasts one to five days depending on the type of procedure being done; many of our patients undergoing a micro discectomy may even go home the next day of surgery. The duration of stay is decided by a number of factors such as general health of patient, the type of surgery done, comorbidities that the patient has etc

What are the risks associated with spinal surgery ?

The biggest risk is a lack of pain relief. A recently published extensive review of the literate indicates spinal fusion has an associated satisfactory relief of pain in the 70%-80% range – meaning 20%- 30% of patients who undergo a spinal fusion do not receive adequate pain relief. This would be by far the biggest risk. A disc herniation operation performed on the appropriate patient has more than 95% chance of success in terms of alleviating severe buttock and leg pain. The other risks of surgery are extremely rare, including infection and nerve injury.

How quickly can I expect to recover from surgery ?

A herniated disc operation performed to relieve severe radiating leg pain typically has relief of leg pain in a matter of hours or days. Often it may take months to recover the sensation or motor deficits of a herniated disc and sometimes this never happens. Most surgeons would ask the patient to refrain from extensive lifting, twisting, bending and stooping for 4-6 weeks following a disc operation, at which point normal activities can be started again. A fusion operation often takes 4- 6months for bone fusion. Therapy for each patint is individualized to help achieve the best results.

Will I have to take medication for pain? Are there any medications I should be concerned about ?

It is common for patients to require pain medications following surgery for sometime.

How many times will I need to see my surgeon after surgery ?

In general, a patient would see the surgeon approximately two weeks after surgery for suture removal and then at that point, six weeks, three months, six months, and a year