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Spinal Fusion (2010)
Spinal Fusion (2010)
Published: 2010/04/30
Channel: Nucleus Medical Media
Lumbar Fusion of L5 S1 Animation
Lumbar Fusion of L5 S1 Animation
Published: 2016/10/07
Channel: Wes Cary
Scoliosis Surgery - Posterior Spinal Instrumented Fusion, Surgeon: Shyam Kishan, MD
Scoliosis Surgery - Posterior Spinal Instrumented Fusion, Surgeon: Shyam Kishan, MD
Published: 2012/08/22
Channel: Shyam Kishan
Spinal Fusion - Day 1
Spinal Fusion - Day 1
Published: 2011/09/28
Channel: treadbroker
Posterior Revision Decompression and Lumbar Fusion Surgery of the Spine
Posterior Revision Decompression and Lumbar Fusion Surgery of the Spine
Published: 2014/12/11
Channel: MedStar Health
My Life after Spinal Fusion L4 L5 S1 Surgery | Beautifully Blended
My Life after Spinal Fusion L4 L5 S1 Surgery | Beautifully Blended
Published: 2015/09/01
Channel: Beautifully Loc'd
L5-S1 Spinal Fusion Surgery and Week One Recovery
L5-S1 Spinal Fusion Surgery and Week One Recovery
Published: 2016/04/28
Channel: Creative Mechanic
Lumbar spine decompression and fusion surgery
Lumbar spine decompression and fusion surgery
Published: 2014/04/18
Channel: Khalid Al-Kharazi
PLIF (Lower Back Fusion) Surgery
PLIF (Lower Back Fusion) Surgery
Published: 2009/08/18
Channel: Tony Armer
L4 L5 Spinal Fusion, 6 weeks post op
L4 L5 Spinal Fusion, 6 weeks post op
Published: 2015/01/05
Channel: Kyle Peek
Spinal fusion side effects
Spinal fusion side effects
Published: 2011/01/21
Channel: WPTV News | West Palm Beach Florida
Live Spine Surgery: Minimally Invasive Lumbar Fusion
Live Spine Surgery: Minimally Invasive Lumbar Fusion
Published: 2016/02/02
Channel: El Paso Spine Center
My Scar & Spinal Fusion Surgery Experience // Why I Have A Giant Scar
My Scar & Spinal Fusion Surgery Experience // Why I Have A Giant Scar
Published: 2016/05/23
Channel: Julia Cates
Back Surgery | Spinal Fusion | Nucleus Health
Back Surgery | Spinal Fusion | Nucleus Health
Published: 2015/06/12
Channel: Nucleus Medical Media
One year post lumbar spinal fusion
One year post lumbar spinal fusion
Published: 2017/06/21
Channel: poppy red
My Surgery Story - Spinal Fusion
My Surgery Story - Spinal Fusion
Published: 2013/09/28
Channel: LilyandLife
Minimally Invasive Lumbar Fusion Surgery - MIS TLIF
Minimally Invasive Lumbar Fusion Surgery - MIS TLIF
Published: 2013/05/20
Channel: cdaspine
Weightlifting & Running After Spinal Fusion
Weightlifting & Running After Spinal Fusion
Published: 2015/06/16
Channel: LIVESTRONG.COM
Spinal Fusion Back Surgery
Spinal Fusion Back Surgery
Published: 2015/12/04
Channel: Borgess Health
Posterior Spinal Fusion
Posterior Spinal Fusion
Published: 2014/12/16
Channel: MediVisuals
Spinal Fusion Surgery Recovery
Spinal Fusion Surgery Recovery
Published: 2015/07/10
Channel: Vivek Kushwaha
Spinal Fusion - Hardware Out
Spinal Fusion - Hardware Out
Published: 2014/05/12
Channel: treadbroker
A look at Tiger Woods
A look at Tiger Woods' L5/S1 spinal fusion back surgery
Published: 2017/04/21
Channel: Golf News Net
Spinal Fusion & Synthaya - TerraNova ᴴᴰ
Spinal Fusion & Synthaya - TerraNova ᴴᴰ
Published: 2017/07/24
Channel: Progressive Universe
Spinal Fusion - Live - Freqs Of Nature 2015
Spinal Fusion - Live - Freqs Of Nature 2015
Published: 2016/01/29
Channel: MrLemilica2
First time getting up 3 hours post lumbar  fusion surgery
First time getting up 3 hours post lumbar fusion surgery
Published: 2013/04/24
Channel: Starla McLean
Spinal Fusion Surgery - Don
Spinal Fusion Surgery - Don't Do It!
Published: 2011/10/26
Channel: Nathan Wei
Spinal Fusion Surgery: What to Expect | IU Health
Spinal Fusion Surgery: What to Expect | IU Health
Published: 2015/12/04
Channel: IUHealth
Spinal Fusion | Richard Shetter
Spinal Fusion | Richard Shetter's Story
Published: 2017/01/31
Channel: Johns Hopkins Medicine
Recovery after Posterior Lumbar Spinal Fusion and Disk Replacement- Video 1
Recovery after Posterior Lumbar Spinal Fusion and Disk Replacement- Video 1
Published: 2016/12/14
Channel: Tori Jane
Spinal Fusion - 6 months
Spinal Fusion - 6 months
Published: 2012/03/27
Channel: treadbroker
Anterior Lumbar Interbody Fusion Overview
Anterior Lumbar Interbody Fusion Overview
Published: 2015/01/15
Channel: Atlantic Spine Center
Lumbar Spinal Fusion - This is my journey - episode 4: Day 2 through 6 of Recovery
Lumbar Spinal Fusion - This is my journey - episode 4: Day 2 through 6 of Recovery
Published: 2014/12/08
Channel: Ryan Malpica
Session Sit In:  Low Back Pain, Post-Op Spinal Fusion
Session Sit In: Low Back Pain, Post-Op Spinal Fusion
Published: 2017/05/29
Channel: Athletic Movement Protocol
Avalon - Distant Futures (Spinal Fusion Remix)
Avalon - Distant Futures (Spinal Fusion Remix)
Published: 2017/03/29
Channel: Nano Records
Spinal Fusion & Hypnocoustics - Enigma ᴴᴰ
Spinal Fusion & Hypnocoustics - Enigma ᴴᴰ
Published: 2017/02/06
Channel: Psychedelic Universe
Spinal Fusion & M-Theory - SuperNova
Spinal Fusion & M-Theory - SuperNova
Published: 2016/08/05
Channel: Trancentral
L5 S1 Anterior and Posterior Discectomy and Spinal Fusion
L5 S1 Anterior and Posterior Discectomy and Spinal Fusion
Published: 2014/11/20
Channel: Anand Orthopaedic Hospital
Core Exercises for Spinal Fusion (and more!) | FemFusion Fitness
Core Exercises for Spinal Fusion (and more!) | FemFusion Fitness
Published: 2017/01/16
Channel: FemFusion Fitness
Anterior Cervical Decompression and Fusion (ACDF) | Live Spine Surgery Video | Spine Surgeon
Anterior Cervical Decompression and Fusion (ACDF) | Live Spine Surgery Video | Spine Surgeon
Published: 2010/05/04
Channel: Donald Corenman, MD, DC
Lumbar Laminectomy And Fusion
Lumbar Laminectomy And Fusion
Published: 2016/12/08
Channel: Watauga IT Admin
How Can a Patient Improve Recovery After Lumbar Fusion Surgery? - Keola Chun, MD - Spine Surgery
How Can a Patient Improve Recovery After Lumbar Fusion Surgery? - Keola Chun, MD - Spine Surgery
Published: 2016/03/03
Channel: Riverside Community Hospital
Spinal Fusion & Mystic - A Better One
Spinal Fusion & Mystic - A Better One
Published: 2016/06/20
Channel: DZP Music
MIS TLIF Spinal Fusion Surgery, L4-L5-S1, 2 Weeks Post-Op
MIS TLIF Spinal Fusion Surgery, L4-L5-S1, 2 Weeks Post-Op
Published: 2012/04/06
Channel: Derek Spratt
Spinal fusion-Sex after lumbar fusion, 3 weeks post op
Spinal fusion-Sex after lumbar fusion, 3 weeks post op
Published: 2016/07/12
Channel: poppy red
MY LUMBAR SPINAL FUSION SURGERY FOR SPONDYLOLISTHESIS - Leah Smith 13 year old Gymnast
MY LUMBAR SPINAL FUSION SURGERY FOR SPONDYLOLISTHESIS - Leah Smith 13 year old Gymnast
Published: 2016/11/07
Channel: LEAH SMITH Spondylolisthesis Journey
Lumbar 360 Spinal Fusion Surgery L5-S1
Lumbar 360 Spinal Fusion Surgery L5-S1
Published: 2017/06/24
Channel: Candy Raines
Spinal Fusion Pain Management
Spinal Fusion Pain Management
Published: 2015/07/09
Channel: Vivek Kushwaha
3D Medical Animation | Lumbar spine surgical procedure.  2 level fusion of L4-S1
3D Medical Animation | Lumbar spine surgical procedure. 2 level fusion of L4-S1
Published: 2012/07/31
Channel: Medical Art Works
Spine Fusion Surgery
Spine Fusion Surgery
Published: 2015/02/14
Channel: Dr.Tahir Ahmed
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WIKIPEDIA ARTICLE

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Spinal fusion
Roe LWS Spondylodese L5-S1 seitlich.jpg
Fusion of L5 and S1
ICD-9-CM 81.0
MeSH D013123
MedlinePlus 002968

Spinal fusion, also called spondylodesis or spondylosyndesis, is a neurosurgical or orthopedic surgical technique that joins two or more vertebrae. This procedure can be performed at any level in the spine (cervical, thoracic, or lumbar) and prevents any movement between the fused vertebrae. There are many types of spinal fusion and each technique involves using bone grafting - either from the patient (autograft), donor (allograft), or artificial bone substitutes - to help the bones heal together.[1] Additional hardware (screws, plates, or cages) is often used to hold the bones in place while the graft fuses the two vertebrae together.

Spinal fusion is most commonly performed to relieve the pain and pressure on the spinal cord that results when a disc (cartilage between two vertebrae) wears out (degenerative disc disease).[2] Other common pathological conditions that are treated by spinal fusion include spinal stenosis, spondylolisthesis, spondylosis, spinal fractures, scoliosis, and kyphosis.[2]

Like any surgery, complications may include infection, blood loss, and nerve damage.[3] Fusion also changes the normal motion of the spine and results in more stress on the vertebrae above and below the fused segments. As a result, long-term complications include degeneration at these adjacent spine segments.[1]

Medical uses[edit]

Spinal fusion can be used to treat a variety of conditions affecting any level of the spine - lumbar, cervical and thoracic. In general, spinal fusion is performed to decompress and stabilize the spine.[3] The most common cause of pressure on the spinal cord/nerves is degenerative disc disease.[4] Other common causes include disc herniation, spinal stenosis, trauma, and spinal tumors.[3] Spinal stenosis results from bony growths (osteophytes) or thickened ligaments that cause narrowing of the spinal canal over time.[3] This causes leg pain with increased activity, a condition called neurogenic claudication.[3] Pressure on the nerves as they exit the spinal cord (radiculopathy) causes pain in the area where the nerves originated (leg for lumbar pathology, arm for cervical pathology).[3] In severe cases, this pressure can cause neurologic deficits, like numbness, tingling, bowel/bladder dysfunction, and paralysis.[3]

Lumbar and cervical spinal fusions are more commonly performed than thoracic fusions.[4] Degeneration happens more frequently at these levels due to increased motion and stress.[4] The thoracic spine is more immobile, so most fusions are performed due to trauma or deformities like scoliosis and kyphosis.[3]

Herniated disc pressing on spinal nerves.

Conditions where spinal fusion may be considered include the following:

Contraindications[edit]

Bone morphogenetic protein (rhBMP) should not be routinely used in any type of anterior cervical spine fusion, such as with anterior cervical discectomy and fusion.[5] There are reports of this therapy causing soft tissue swelling, which in turn can cause life-threatening complications due to difficulty swallowing and pressure on the respiratory tract.[5]

Epidemiology[edit]

According to a report by the Agency for Healthcare Research and Quality (AHRQ), approximately 488,000 spinal fusions were performed during U.S. hospital stays in 2011 (a rate of 15.7 stays per 10,000 population), which accounted for 3.1% of all operating room procedures.[6] This was a 70 percent growth in procedures from 2001.[7] Lumbar fusions are the most common type of fusion performed ~ 210,000 per year. 24,000 thoracic fusions and 157,000 cervical fusions are performed each year.[4]

A 2008 analysis of spinal fusions in the United States reported the following characteristics:

  • Average age for someone undergoing a spinal fusion was 54.2 years - 53.3 years for primary cervical fusions, 42.7 years for primary thoracic fusions, and 56.3 years for primary lumbar fusions [4]
  • 45.5% of all spinal fusions were on men [4]
  • 83.8% were white, 7.5% black, 5.1% Hispanic, 1.6% Asian or Pacific Islander, 0.4% Native American [4]
  • Average length of hospital stay was 3.7 days - 2.7 days for primary cervical fusion, 8.5 days for primary thoracic fusion, and 3.9 days for primary lumbar fusion [4]
  • In-hospital mortality was 0.25% [4]

Costs[edit]

Costs associated with spinal fusion vary depending on the medical institution, insurance, type of surgery and the overall health of the patient.[8] Total costs typically include labs, medications, room & board, medical supplies, recovery room, operating room services, physical therapy, imaging, and hospital charges.[9] The average total hospital costs for spinal fusions increased from $24,676 in 1998 to $81,960 in 2008.[4] The average total costs of common fusion procedures are listed below:

  • $34,943 - Anterior cervical discectomy and fusion (ACDF) for someone with severe obesity and diabetes (2005-2008) [8]
  • $25,633 - ACDF for someone without obesity and diabetes (2005-2008) [8]
  • $65,782 - Lumbar decompression and fusion (LDF) for someone with diabetes and depression (2005-2008) [8]
  • $52,249 - LDF for someone without diabetes or depression (2005-2008) [8]
  • $80,095 - Upper thoracic level primary spinal fusion (2003-2013) [9]
  • $55,547 - Revision of previous fusion surgery due to adjacent segment disease (2003-2013) [9]

Technique[edit]

There are many types of spinal fusion techniques. Each technique varies depending on the level of the spine and the location of the compressed spinal cord/nerves.[3] After the spine is decompressed, bone graft or artificial bone substitute is packed between the vertebrae to help them heal together.[1] In general, fusions are done either on the anterior (stomach), posterior (back), or both sides of the spine.[3] Today, most fusions are supplemented with hardware (screws, plates, rods) because they have been shown to have higher union rates than non-instrumented fusions.[3] Minimally invasive techniques are also becoming more popular.[10] These techniques use advanced image guidance systems to insert rods/screws into the spine through smaller incisions, allowing for less muscle damage, blood loss, infections, pain, and length of stay in the hospital.[10] The following list gives examples of common types of fusion techniques performed at each level of the spine:

Anterior approach to cervical spine.

Cervical spine[edit]

Thoracic spine[edit]

  • Anterior decompression and fusion[3]
  • Posterior instrumentation and fusion – many different types of hardware can be used to help fuse the thoracic spine including sublaminar wiring, pedicle and transverse process hooks, pedicle screw-rod systems, vertebral body plate systems.[3]

Lumbar spine[edit]

  • Posterolateral Fusion - bone graft is placed between the transverse processes in the back of the spine. These vertebrae are then fixed in place with screws and/or wire through the pedicles of each vertebra attaching to a metal rod on each side of the vertebrae.
  • Interbody Fusion - the entire intervertebral disc between vertebrae is removed and bone graft is placed in the space between the vertebra. A plastic or titanium device may be placed between the vertebra to maintain spine alignment and disc height. The types of interbody fusion are:
    1. Anterior lumbar interbody fusion (ALIF) – the disc is accessed from an anterior abdominal incision
    2. Posterior lumbar interbody fusion (PLIF) – the disc is accessed from a posterior incision
    3. Transforaminal lumbar interbody fusion (TLIF) – the disc is accessed from a posterior incision on one side of the spine
    4. Transpsoas interbody fusion (DLIF or XLIF) – the disc is accessed from an incision through the psoas muscle on one side of the spine
    5. Oblique lateral lumbar interbody fusion (OLLIF) – the disc is accessed from an incision through the psoas muscle obliquely
Stabilization rods used after spinal fusion surgery.

Risks[edit]

Spinal fusion is a high risk surgery and complications can be serious, including death. In general, there is a higher risk of complications in older people with elevated body mass index (BMI), other medical problems, poor nutrition and nerve symptoms (numbness, weakness, bowel/bladder issues) before surgery.[3] Complications also depend on the type/extent of spinal fusion surgery performed. There are three main time periods where complications typically occur:

During surgery[edit]

  • Patient positioning on operating table [3]
  • Blood loss [3]
  • Damage to nerves and surrounding structures during procedure [3]
  • Insertion of spinal hardware [3]
  • Harvesting of bone graft (if autograft is used) [3]

Within a few days[edit]

Weeks to years following surgery[edit]

  • Infection[3]
  • Deformity - loss of height, alignment, and failure of fusion [3]
  • Pseudarthrosis - nonunion between fused bone segments. Risk factors include tobacco use, nonsteroidal anti-inflammatory drug use, osteoporosis, revision procedures, decreased immune system.[3]
  • Adjacent segment disease - degeneration of vertebrae above/below the fused segments due to increased stress and motion.[3]
  • Epidural fibrosis - scarring of the tissue that surrounds the spinal cord[3]
  • Arachnoiditis - inflammation of the thin membrane surrounding the spinal cord, usually caused by infection or contrast dye.[3]

Recovery[edit]

Recovery following spinal fusion is extremely variable, depending on individual surgeon's preference and the type of procedure performed.[11] The average length of hospital stay for spinal fusions is 3.7 days.[4] Some patients can go home the same day if they undergo a simple cervical spinal fusion at an outpatient surgery center.[12] Minimally invasive surgeries are also significantly reducing the amount of time spent in the hospital.[12] Recovery typically involves both restriction of certain activities and rehabilitation training.[13] Restrictions following surgery largely depend on surgeon preference. A typical timeline for common restrictions after a lumbar fusion surgery are listed below:

  • Walking - most people are out of bed and walking the day after surgery[13]
  • Sitting - can begin at 1–6 weeks following surgery[13]
  • Lifting - it is generally recommended to avoid lifting until 12 weeks[13]
  • Driving - usually can begin at 3–6 weeks[13]
  • Return to sedentary work - usually between 3–6 weeks[13]
  • Return to manual work - between 7–12 weeks[13]

Rehabilitation after spinal fusion is not mandatory. There is some evidence that it improves functional status and low back pain so some surgeons may recommend it.[13]

Society[edit]

Frequency of use[edit]

According to a report by the Agency for Healthcare Research and Quality (AHRQ), approximately 488,000 spinal fusions were performed during U.S. hospital stays in 2011 (a rate of 15.7 stays per 10,000 population), which accounted for 3.1% of all operating room procedures.[6]

People who underwent spinal fusion[edit]

References[edit]

  1. ^ a b c Chou, Roger (March 11, 2016). "Subacute and Chronic Low Back Pain: Surgical Treatment". UpToDate. 
  2. ^ a b Rajaee, Sean (2012). "Spinal Fusion in the United States". Spine. 37: 67–76. 
  3. ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae af ag ah ai aj Agulnick, Marc (2017). Orthopaedic Surgery Essentials: Spine. Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103 USA: Lippincott Williams & Wilkins. p. 343. ISBN 978-1-49631-854-1. 
  4. ^ a b c d e f g h i j k Rajaee, Sean S.; Bae, Hyun W.; Kanim, Linda E.A.; Delamarter, Rick B. "Spinal Fusion in the United States". Spine. 37 (1): 67–76. doi:10.1097/brs.0b013e31820cccfb. 
  5. ^ a b North American Spine Society (February 2013), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation, North American Spine Society, retrieved 25 March 2013 , which cites
  6. ^ a b Weiss AJ, Elixhauser A, Andrews RM (February 2014). "Characteristics of Operating Room Procedures in U.S. Hospitals, 2011.". HCUP Statistical Brief #170. Rockville, MD: Agency for Healthcare Research and Quality. 
  7. ^ Weiss AJ, Elixhauser A (March 2014). "Trends in Operating Room Procedures in U.S. Hospitals, 2001—2011.". HCUP Statistical Brief #171. Rockville, MD: Agency for Healthcare Research and Quality. 
  8. ^ a b c d e Walid, M. Sami; Robinson, Joe Sam (2011-01-14). "Economic impact of comorbidities in spine surgery". Journal of Neurosurgery: Spine. 14 (3): 318–321. ISSN 1547-5654. doi:10.3171/2010.11.SPINE10139. 
  9. ^ a b c Theologis, Alexander A.; Miller, Liane; Callahan, Matt; Lau, Darryl; Zygourakis, Corinna; Scheer, Justin K.; Burch, Shane; Pekmezci, Murat; Chou, Dean (2016-08-15). "Economic Impact of Revision Surgery for Proximal Junctional Failure After Adult Spinal Deformity Surgery". Spine. 41 (16): E964–E972. ISSN 1528-1159. doi:10.1097/brs.0000000000001523. 
  10. ^ a b Phan, Kevin; Rao, Prashanth J.; Mobbs, Ralph J. (2015-08-01). "Percutaneous versus open pedicle screw fixation for treatment of thoracolumbar fractures: Systematic review and meta-analysis of comparative studies". Clinical Neurology and Neurosurgery. 135: 85–92. ISSN 1872-6968. PMID 26051881. doi:10.1016/j.clineuro.2015.05.016. 
  11. ^ McGregor, Alison H.; Dicken, Ben; Jamrozik, Konrad (2006-05-31). "National audit of post-operative management in spinal surgery". BMC Musculoskeletal Disorders. 7: 47. ISSN 1471-2474. PMC 1481518Freely accessible. PMID 16737522. doi:10.1186/1471-2474-7-47. 
  12. ^ a b Shields, Lisa B. E.; Clark, Lisa; Glassman, Steven D.; Shields, Christopher B. (2017-01-19). "Decreasing hospital length of stay following lumbar fusion utilizing multidisciplinary committee meetings involving surgeons and other caretakers". Surgical Neurology International. 8. ISSN 2229-5097. PMC 5288986Freely accessible. PMID 28217384. doi:10.4103/2152-7806.198732. 
  13. ^ a b c d e f g h McGregor, Alison H.; Probyn, Katrin; Cro, Suzie; Doré, Caroline J.; Burton, A. Kim; Balagué, Federico; Pincus, Tamar; Fairbank, Jeremy (2013-12-09). "Rehabilitation following surgery for lumbar spinal stenosis". The Cochrane Database of Systematic Reviews (12): CD009644. ISSN 1469-493X. PMID 24323844. doi:10.1002/14651858.CD009644.pub2. 
  14. ^ "Phil Jackson". Nba.com. Retrieved November 9, 2013. 
  15. ^ Mcgair, Brendan. "Red Sox OF Kalish hopes latest surgery does the trick". The Pawtucket Times. Retrieved November 9, 2013. 
  16. ^ "The NHL's Most Interesting Name: 1960s Part II". Arctic Ice Hockey. Retrieved November 9, 2013. 
  17. ^ "Spinal fusion surgery: The science behind Manning's life changing operation". News.medill.northwestern.edu. February 2, 2012. Retrieved November 9, 2013. 
  18. ^ "Cheryl Raye-Stout reviews some key moments from the 2012 Summer Olympic Games in London". Wbez.org. August 13, 2012. Retrieved November 9, 2013. 
  19. ^ Schwab, Frank (February 6, 2014). "Jermichael Finley excited to play again after spinal fusion surgery | Shutdown Corner". Sports.yahoo.com. Retrieved March 28, 2014. 
  20. ^ Tweddell, Ross (December 5, 2014). "Andrew ‘Test’ Martin underwent spinal fusion surgery in July 2004 under Dr. Lloyd Youngblood". Retrieved January 29, 2016 – via whatculture.com. 

Further reading[edit]

External links[edit]

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