Spinal Fusion (with or without instrumentation)

Why fusion?

At the most basic level fusion surgery is carried out to stabilise the spinal column by connecting stable vertebral bodies with those that are unstable.

Conditions

There are a wide range of conditions of the back that can be treated by fusion surgery. Some of these conditions include:

1. Degenerative disc disease defined as back pain of discogenic origin with degeneration of the disc confirmed by history and radiographic studies;
2. Spondylolisthesis (directional movement of one part of the spine in relation to another causing instability);
3. Trauma (i.e. fracture or dislocation);
4. Spinal stenosis (narrowing of spaces where nerves leave spinal canal and branch out to other parts of the body);
5. Deformities or curvatures (i.e. scoliosis, kyphosis, and/or lordosis correction);
6. Spinal tumour (i.e. for recontruction after removal of tumour);
7. Pseudarthrosis; or
8. For revision of previous spinal surgery that has either failed or the condition has worsened requiring further stabilisation of multiple levels of the spine.

Symptoms

Each of the conditions above can present with similar symptoms. Back pain, leg pain, loss of sensation or feeling are among the common symptoms. Anyone suffering these symptoms should make an appointment with their doctor as soon as possible.

Diagnosis

A primary care doctor (or General Pratitioner) will make a referral to a back specialist such as a consultant spinal surgeon if there are signs indicating any of the conditions listed above, following an appointment with a patient. 

A consultant spinal surgeon will be able to determine accurately the nature of the problem through careful examination or at least rule out any conditions that could not be causing the problem. An x-ray or MRI scan will assist in identifying the precise location of the problem and confirm the diagnosis. The consultant will then be able to discuss the available treatment options available based on the diagnosis.

Surgery

Spinal fusion may be performed on its own or at the same time as laminectomy (also known as decompression for spinal stenosis). It's used to permanently connect (fuse) two or more vertebral bones in the spine and may be especially indicated when one vertebra slips directionally over another. This type of surgery is carried out under general anaesthetic. 

To fuse the spine, the consultant spinal surgeon will make a small incision (dependent on the extent of the instability) and place small pieces of bone bone across the affected area to encourage new bone growth and over time this will fuse with the adjacent vertebrae. This bone may come from a bone bank or from your own body, usually your pelvic bone.

Wires, rods, screws, metal cages or plates also may be used, especially if your spine is unstable or the operation takes place to correct a deformity.

Dynamic stabilisation

Increasingly new technology attempts to addess some of the limitation of fusion surgery. Dynamic stabilisation is one such example. Particularly in younger patients where signs of instability are already appearing traditional fusion options may not be ideal since it will be restrictive on movement.

With certain types of dynamic stabilisation a special polymer is used to join one level in the spine to another, as shown in the diagram to the right. [image to be inserted]

This is designed to give a patient relief from the symptoms associated with instability of the spine but leave them with more flexibility and a better range of movement than when using all metal implants. This type of technology is relatively new and unproven compared with traditional methods but has already started to show some good results.

After surgery

A patient will normally stay in hospital for three to four days following a spinal fusion. With minimally invasive advances in surgical techniques it is even possible to sit up and walk short distances with the aid of crutches or a walker only hours after surgery. The hospital's nurses and physiotherapists will spend the most time with each patient and determine the most appropriate mobilisation programme tailored to each individual.  Detailed booklets will be provided for easy reference. 

The exercises learned while in hospital will be a very important part of the long term success of the spinal fusion and should be continued as a part of a daily routine as prescribed by the physiotherapists. 

Patients will be asked to attend a follow up appointment four to six weeks after leaving hospital to see their consultant surgeon who will review progress and, if appropriate, make recommendations or adjustments to a patient's activities at that time.

For any enquiries please contact Mrs Mandy O'Sullivan who will endeavour to help you in any way possible.