 Writers' Community! |
|
| Home Page Two Columnists Q&A Submit an Article FAQs Contact Author Login |
BackCare Spinal Health BackCare SupportTerry O'Brien (2,036)    Terry O'Brien   Back Trouble UK Don't Be Confused About Spinal Fusion!Posted Thursday, October 01, 2009 (38 days 6 hours ago.) Viewed 41 times.  Spinal fusion is a surgical procedure in which two or more vertebrae are joined or fused together. Fusion surgeries typically require the use of bone graft to facilitate fusion.
This involves taking small amounts of bone from the patient's pelvic bone (autograft), or from a donor (allograft), and then packing it between the vertebrae in order to "fuse" them together. This can be accomplished either posteriorly or between the vertebral bodies. When it is done between vertebral bodies, bone graft, along with a biomechanical spacer implant, will take the place of the intervertebral disc, which is entirely removed in the process. Spinal fusion surgery is a common treatment for such spinal disorders as spondylolisthesis, scoliosis, severe disc degeneration, or spinal fractures. Fusion surgery is usually considered only after extensive non-operative therapies have failed. Three common fusion surgeries available at Specialist Surgical Units include posterior fusion and interbody fusion such as PLIF, ALIF, TLIF or XLIF. PLIF PLIF stands for Posterior Lumbar Interbody Fusion. In this fusion technique, the vertebrae are reached through an incision in the patient's back (posterior). The PLIF procedure involves three basic steps: Pre-operative planning and templating. Before the surgery, the surgeon uses MRI and CAT scans to determine what size implant(s) the patient needs. Preparing the disc space. Depending on the number of levels to be fused, a 3-6 inch incision is made in the patient's back and the spinal muscles are retracted (or separated) to allow access to the vertebral disc. The surgeon then carefully removes the lamina (laminectomy) to be able to see and access the nerve roots. The facet joints, which lie directly over the nerve roots, may be trimmed to allow more room for the nerve roots. The surgeon then removes the affected disc and surrounding tissue and prepares bone surfaces of adjacent vertebrae for fusion. Implants inserted. Once the disc space is prepared, bone graft, allograft, or BMP with a cage (a biomechanical spacer implant) is inserted into the disc space to promote fusion between the vertebrae. The implant (cage) may be made of bone, metal, carbon fiber or other material. Additional instrumentation (such as rods or screws) will also be used at this time to further stabilize the spine. Most surgeons do not recommend this procedure without using fixation because of high complications. TLIF TLIF stands for Transforaminal Lumbar Interbody Fusion. This fusion surgery is a refinement of the PLIF procedure and has recently gained popularity as another technique of surgical treatment for conditions affecting the lumbar spine. The TLIF technique involves approaching the spine in a similar manner as the PLIF approach but more from the side of the spinal canal through a midline incision in the patient's back. This approach reduces the amount of surgical muscle dissection and minimizes the nerve manipulation required to access the vertebrae, discs and nerves. The TLIF approach is generally less traumatic to the spine, is safer for the nerves, and allows for minimal access and endoscopic techniques to be used for spinal fusion. As with PLIF and ALIF, disc material is removed from the spine and replaced with bone graft (along with cages, screws, or rods if necessary) inserted into the disc space. The instrumentation helps facilitate fusion while adding strength and stability to the spine. Currently surgeons use many state of the art cage technologies including those made of bone, titanium, polymer, and even bioresorbable materials. ALIF ALIF stands for Anterior Lumbar Interbody Fusion. This procedure is similar to PLIF, however it is done from the front (anterior) of the body, usually through an incision in the lower abdominal area or on the side. This incision may involve cutting through, and later repairing, the muscles in the lower abdomen. At our practice, a mini open ALIF approach is available that preserves the muscles and allows access to the front of the spine through a very small incision. This approach maintains abdominal muscle strength and function and is oftentimes used to fuse the L5-S1 disc space. Once the incision is made and the vertebrae are accessed, and after the abdominal muscles and blood vessels have been retracted, the disc material is removed. The surgeon then inserts bone graft (and anterior interbody cages, rods, or screws if necessary) to stabilized the spine and facilitate fusion. XLIF XLIF stands for eXtreme Lateral Interbody Fusion. This is a relatively new minimally invasive approach to the anterior spine that avoids an incision that traverses the abdomen and also avoids cutting or disrupting the muscles of the back. In this fusion technique, the disk space is accessed from a very small incision on the patient's side (flank) a couple of inches in length, occasionally with another small incision (one inch long) just behind the first incision. Special retractors are utilized, in addition to a fluoroscopy machine, which provides real-time x-ray images of the spine. In addition, special monitoring equipment is used to determine the proximity of the working instruments to the nerves of the spine. The disk material is removed from the spine and replaced with a bone graft, along with structural support from a cage made of bone, titanium, carbon-fiber, or a polymer. This technique typically allows a shorter hospital stay and may be less painful than traditional approaches to the spine, however it also has limitations. Only those vertebra of the spine that have clear access from the side of the body can be approached using this technique. Also, only one or two levels can usually be accessed via this method. Minimal Access Spinal Surgeons routinely do several types of spinal procedures utilizing minimal access techniques. The development of these techniques originated with the application of endoscopy during microdiscectomy surgery for herniated lumbar discs. It has now been applied to fusion surgeries. Ask your consultant if this could be appropriate for you. After Fusion Surgery Recovery time is different for every patient. However, most patients are up and walking by the end of the first day after surgery. Most patients can expect to stay in the hospital for 3-5 days depending on their condition. Once released from the hospital, patients who have undergone surgery are given a prescription for pain medications to be taken if needed, as well as a detailed post-operative activity, physical therapy/exercise plan to help ease recovery and return to a healthy life. Terry O'Brien 
Permalink Comments (0) Stabilising the Spine and the Dynesys SystemPosted Monday, August 24, 2009 (76 days 5 hours ago.) Viewed 18 times. If your Spine Specialist discovers that a combination of physical therapy and medication does not solve your back problem, then they will order further diagnostic tests to help find the root cause of the pain and determine the severity of the problem. You should fill out a questionnaire about your symptoms, pain and mobility, and the specialist will complete a series of tests, including dynamic radiography for imaging and/or an MRI (Magnetic Resonance Imaging). Taking into consideration your history, condition and situation, your specialist will use the test results to determine an appropriate treatment for you. Non-Surgical Treatment Non-surgical or conservative treatment consists of a combination of rest, weight control, exercise, physical therapy, application of heat and cold, injections and/or anti-inflammatory medications. The persistence of pain is evaluated after this treatment. A spine specialist will decide whether surgical treatment is necessary. Surgical Treatment Your doctor may recommend surgical treatment under anaesthesia to realign the spine, restore the space between vertebrae and relieve pressure on the nerves that are causing pain. An anaesthesia test will be completed before surgery to evaluate possible risks. Your history, condition, diagnosis and the goals of the surgery are all considered when determining the best surgical procedure for you. Depending on the level of disc degeneration, the surgeon will choose between rigid fixation (which fuses vertebrae) and non-rigid fixation (also called dynamic stabilisation). Spinal fusion, in which the affected discs are removed and the associated vertebrae gradually fuse together through new bone growth, has historically been the standard treatment and is still in use depending on the patient's conditions. An implant of screws and inflexible rods holds the vertebrae in place during the fusion process. A non-rigid, dynamic implant system is an alternative to fusion. Flexible materials between screws help to preserve anatomical structures, restore the healthy alignment of the vertebrae and relieve the weight overload on the vertebrae adjacent to the implant. Spinal Fusion Surgery Depending on the condition of the spine, the doctor may use an anterior approach, which means the incision will be in the abdomen, or a posterior approach, which means the incision, will be in the back. Sometimes the doctor may choose to use a combination of the two. If the doctor uses a posterior approach, then a pedicle screw system is used to stabilise the spine while it fuses. The pedicle screw system may be used alone or it can be combined with another stabilising device. During surgery, the doctor may relieve the nerve compression by removing the disc (the procedure is called a discectomy). The doctor may also relieve pressure on the nerve by trimming or removing the roof, or lamina, of the vertebra to create more space for the nerve (called laminectomy ). The doctor then restores the space around the nerves and prepares to stabilise the spine with the pedicle screw system. There are a number of components in a pedicle screw system, and the doctor will choose the ones that will work best for your spine. The screws are placed through each side of the vertebrae in the part of the part of the bone called the pedicle. Rods are then attached to connect the screws and hold the spine in its restored position. The pedicle screw system is now secure. In the last step of the surgery, the doctor places bone graft (small chips of bone ) alongside of the vertebrae to be fused or puts the graft in and around a device that's placed between the vertebrae. Bone graft can come from the patient's hipbone, from a bone bank, or from a combination of both. The pedicle screw system will hold the spine stable until the bone graft fuses with the vertebrae. Although bone fusion is a natural biological process, complete fusion can take up to one year. In some cases, people may have trouble fusing their spine. Many things, such as smoking or various medications can interfere with successful fusion. Your doctor will discuss with you the risks associated with your specific surgery. Spinal Non Fusion Surgery with the Dynesys Dynamic Stabilisation System This non-rigid, dynamic implant system is an alternative to fusion. Flexible materials between screws help to preserve anatomical structures, restore the healthy alignment of the vertebrae and relieve the weight overload on the vertebrae adjacent to the implant. How can the Dynesys System help? The Dynesys System is a pedicle-screw fixation system, an implant device consisting of a spacer, cord and pedicle screw. It offers a unique approach to stabilisation and mobilisation of the spine and pain relief - a "dynamic" approach - that relies on flexible materials and preserves much of the spinal anatomy. Which patients are candidates for the Dynesys System? The Dynesys System can be used in skeletally mature patients to provide immobilisation and stabilisation of spinal segments. It is used to treat degenerative disc disease in the lumbar and / or sacral regions when there is evidence of resulting neurologic impairment. Your doctor will decide the best way to perform surgery for your unique conditions. Keep in mind that other factors will also have an impact on your recovery after surgery. Obesity, smoking and psychological problems may decrease your chance for a successful outcome. When should the Dynesys System not be used? The Dynesys System should not be used in the cervical spine or for patients that are obese, pregnant, abuse alcohol or other drugs, or who have:
What does surgery with the Dynesys System involve? The Dynesys System is compatible with conventional posterior surgical techniques, and in some cases can be implanted using a minimally invasive approach. On average, the procedure to implant the Dynesys System takes two to three hours which is similar to the time required for traditional fusion procedures, depending on patient conditions. The Dynesys System is attached to the bony extrusion (pedicle) on each side of the affected segment. Once in place, the components create a dynamic push-pull relationship that stabilises the affected joints and keeps your vertebrae in a natural position. What to Expect Before and After Surgery Before Surgery You are an active participant in the surgery's success. Proper preparation for surgery is mandatory. It is important to be as fit as possible when you go into the clinic; this will help your recovery and enable you to be mobile and active more quickly after surgery. Improve your general health and follow healthy dietary recommendations. Both obesity and smoking increase the risks during the surgery and may complicate recovery. Strengthen your muscles; some exercises may prepare your back muscles for surgery. Therefore your doctor may recommend exercises for you. Inform you doctor of allergies, medicines and antibiotics. Patients who regularly take aspirin must, if recommended by his/ her doctor, stop taking them eight to ten days before surgery. Surgery A spinal implantation follows a very accurate protocol and is a standard operation for spine surgeons. The medical team is familiar with the procedure and is fully equipped to take care of you. The surgery takes place under general anaesthetic. The possible risks with anaesthesia will be discussed with you before surgery. Depending on the most suitable surgical posterior approach, either one or two skin incisions will be made on your lower back. The standard duration of surgery is two hours (1), typically with minimal blood loss. Post-surgical pain is usually controlled by a sedative injection in the spinal canal during surgery.
Any surgery involves risk. Your doctor will inform you about the risks related to the surgery and your case. After Surgery A trained medical team will accompany you in the recovery room. Depending on your condition, you will likely be asked to move around the day after surgery. Early movement is important to beginning an efficient recovery process after a surgery with a dynamic spinal implant. With each new step forward, you improve your future ability to move and improve your quality of life. The day after surgery, measures will be taken to relax muscles; you should be able to make controlled movements. Extensive movements that tax the back are not recommended early on. You back should not be required to withstand too high a load at this point, and you should take care not to start driving too early. Any surgery involves risk. Contact your doctor if you have any of the following symptoms after surgery:
Recovery from spinal fusion surgery happens in stages as your body heals. The first stage of recovery involves the healing of the incision and soft tissues. This will happen over the first few weeks. Movement, such as walking, does a lot to help with healing. You can expect to be doing some walking as soon as the day after surgery, and you will be expected to walk every day after that. Your doctor may also have you go to physical or occupational therapy for gentle exercise in the early weeks of recovery. Your doctor will monitor and evaluate the bone fusion throughout your recovery. This will mean visits to the doctor's office, where x-rays will be taken to see how the bone is fusing. Your doctor will tell you what things you can do to help your recovery. Complete fusion surgery takes months, and recovery is different, for each patient. Depending on how many levels of your spine are fused, you may notice some changes in the flexibility of your back. Your doctor will tell you what you can expect during your recovery. Spinal fusion surgery using a pedicle screw system is designed to stabilise your spine, giving you the ability to move more easily and with less pain. For most people, spinal fusion surgery offers significant relief and improved ability to move and function in their daily lives. This information is meant to help you understand spinal fusion surgery and pedicle screw systems like the Silhouette , OPTIMA ZS or ST360 Systems, so you can work with your doctor to make the treatment decision that is right for you. If you have any questions, please talk to your doctor. After Surgery - Dynesys Dynamic Stabilisation It may take several weeks to fully recover from pain resulting from the surgery. However, you may feel almost immediate relief of any leg pain. Back pain should diminish over time now that the vertebrae have been stabilised and nerves are no longer compressed. In most cases, a short hospital stay is required to ensure you adjust to oral pain medication and can move without any problems. Most patients return home within a few days. Following your surgery, your doctor will prescribe rehabilitation and follow-up visits as needed. It's important to follow your physician's instructions carefully to help ensure a full and quick recovery. You need to modify your normal lifestyle to adjust to your spinal implant. You will gain more stability as your back muscles heal. Though you may be able to continue living life as normal, some measures need to be taken to preserve your back. At Home You need to modify your normal lifestyle to adjust to your spinal implant. Further regular exercises will be recommended to care for your back. These will strengthen muscles and your entire back. Though you may be able to continue living life as normal, some measures need to be taken to preserve your back. To keep from overloading the implant:
As your doctor will explain, any surgery involves risk. After surgery, if you have any of these symptoms, you should contact your doctor:
Surgery always involves some risk. General surgical complications may include:
What to Expect from the Surgery The primary goal of this surgery is to restore segmental stability in order to relieve your back and leg pain. As with any treatment for pain, relief symptoms will vary from patient to patient. How can I improve my chances of a good outcome? It's well known that smoker's experience lower surgery success rates than non-smokers. If you smoke, please consider stopping as far in advance of surgery as possible. In addition, poor nutrition impacts your body's ability to heal itself. Eat well-balanced, nutritional meals as far in advance of surgery as possible.
Permalink Comments (0) |
Archives:
|
||||||||||||||||||||||||||||||||||||||||||||||||||
Home |
Page Two |
FAQ's |
Contact |
Terms of Service |
Article Submission Guidelines |
Questions & Answers |
Privacy |
Mission / About
Copyright © 1999-2009 SearchWarp.com, All Rights Reserved - SearchWarp.com is an IcoLogic, Inc. Company