Spinal fusion is surgery to permanently join together two or more bones in the spine In the most serious cases
Spinal fusion is most often done along with other surgical procedures of the spine. It may be done: oWith other surgical procedures for spinal stenosis, such as foraminotomy or laminectomy oAfter diskectomy in the neck Spinal fusion may be done if you have: oInjury or fractures to the bones in the spine oWeak or unstable spine caused by infections or tumors oSpondylolisthesis, a condition in which one vertebrae slips forward on top of another oAbnormal curvatures, such as those from scoliosis or kyphosis Risks for spine surgery are: oInfection in the wound or vertebral bones oDamage to a spinal nerve, causing weakness, pain, loss of sensation, problems with your bowels or bladder oThe vertebrae above and below the fusion are more likely to wear away, leading to more problems later
Spinal fusion is surgery Outlook (Prognosis)
In the most serious cases, when the condition does not respond to other therapies, surgery may relieve pain caused by back problems or serious musculoskeletal injuries. Some surgical procedures may be performed in a doctor's office under local anesthesia, while others require hospitalization. It may be months following surgery before the patient is fully healed, and he or she may suffer permanent loss of flexibility. Since invasive back surgery is not always successful, it should be performed only in patients with progressive neurologic disease or damage to the peripheral nerves
If you had chronic back pain before surgery, you will likely still have some pain afterward
Outlook (Prognosis) If you had chronic back pain before surgery, you will likely still have some pain afterward. Spinal fusion is unlikely to take away all your pain and other symptoms. It is hard for a surgeon to always predict which patients will improve and how much relief surgery will provide, even when using MRI scans or other tests. Losing weight and getting exercise will increase your chances of feeling better. Future spine problems are possible for all patients after spine surgery. After spinal fusion, the area that was fused together can no longer move. Therefore, the spinal column above and below the fusion are more likely to be stressed when the spine moves, and may have problems later on.
Discectomy & Foraminotomy
Discectomy is one of the more common ways to remove pressure on a nerve root from a bulging disc or bone spur. During the procedure the surgeon takes out a small piece of the lamina (the arched bony roof of the spinal canal) to remove the obstruction below. Foraminotomy is an operation that "cleans out" or enlarges the bony hole (foramen) where a nerve root exits the spinal canal. Bulging discs or joints thickened with age can cause narrowing of the space through which the spinal nerve exits and can press on the nerve, resulting in pain, numbness, and weakness in an arm or leg. Small pieces of bone over the nerve are removed through a small slit, allowing the surgeon to cut away the blockage and relieve the pressure on the nerve.
IntraDiscal Electrothermal Therapy & Nucleoplasty
IntraDiscal Electrothermal Therapy (IDET) uses thermal energy to treat pain resulting from a cracked or bulging spinal disc. A special needle is inserted via a catheter into the disc and heated to a high temperature for up to 20 minutes. The heat thickens and seals the disc wall and reduces inner disc bulge and irritation of the spinal nerve. Nucleoplasty uses radiofrequency energy to treat patients with low back pain from contained, or mildly herniated, discs. Guided by x-ray imaging, a wand-like instrument is inserted through a needle into the disc to create a channel that allows inner disc material to be removed. The wand then heats and shrinks the tissue, sealing the disc wall. Several channels are made depending on how much disc material needs to be removed
Nucleoplasty, Radiofrequency lesioning & Spinal fusion
Radiofrequency lesioning is a procedure using electrical impulses to interrupt nerve conduction (including the conduction of pain signals) for 6 to12 months. Using x-ray guidance, a special needle is inserted into nerve tissue in the affected area. Tissue surrounding the needle tip is heated for 90-120 seconds, resulting in localized destruction of the nerves. Spinal fusion is used to strengthen the spine and prevent painful movements. The spinal disc(s) between two or more vertebrae is removed and the adjacent vertebrae are "fused" by bone grafts and/or metal devices secured by screws. Spinal fusion may result in some loss of flexibility in the spine and requires a long recovery period to allow the bone grafts to grow and fuse the vertebrae together. Spinal laminectomy (also known as spinal decompression) involves the removal of the lamina (usually both sides) to increase the size of the spinal canal and relieve pressure on the spinal cord and nerve roots.
Other surgical procedures to relieve severe chronic pain
Other surgical procedures to relieve severe chronic pain include rhizotomy, in which the nerve root close to where it enters the spinal cord is cut to block nerve transmission and all senses from the area of the body experiencing pain; cordotomy, where bundles of nerve fibers on one or both sides of the spinal cord are intentionally severed to stop the transmission of pain signals to the brain; and dorsal root entry zone operation, or DREZ, in which spinal neurons transmitting the patient's pain are destroyed surgically.