Spondylodesis: What does Spinal Fusion Surgery mean?
Spondylodesis, also called spinal fusion, is a major surgical intervention aimed at addressing issues with the vertebrae (small bones) of the spine. It involves joining two or more vertebrae together so they can heal as a single bone.
While the natural structure of the spine allows for mobility and elasticity in the individual segments, spinal fusion eliminates movement in the joined segments. The goal of this procedure is to eliminate painful movement or improve the stability of the spine.
Typically, a spinal fusion operation is advised when the underlying cause of the pain has been identified by the doctor. This may involve the use of imaging techniques such as X-rays, CT or MRI scans to accurately diagnose the problem.
Spinal fusion surgery can provide relief from various back conditions, including:
- Spondylolisthesis (a condition where one vertebra slips forward over the vertebra below it, resulting in pain)
- Scoliosis (an abnormally curved spine)
- Herniated disc or slip disc
- Fractured vertebra
- Degenerative disc disease
- Spinal stenosis (narrowing of the spinal canal)
- Spinal instability or weakness due to infection, tumour, or severe arthritis
Spinal fusion can sometimes be combined with a discectomy, which is the removal of a damaged or diseased disc. In a discectomy, the disc is removed, and bone grafts are placed in the empty space to maintain the proper distance between the bones. The surgeon then uses the adjacent vertebrae to create a bridge or fusion over the bone grafts, which promotes long-term stability.
In the cervical spine or neck region, a fusion procedure along with a discectomy is called a cervical fusion. Rather than removing a vertebra, the surgeon focuses on removing discs or bone spurs in the cervical spine, which consists of seven vertebrae separated by intervertebral discs.
Spinal Fusion Surgery: how is it performed?
There are multiple techniques used to fuse the spine, but the most common techniques used for a long time by the surgeons are cervical and lumbar techniques. The spinal fusion operation is typically performed using the following steps:
- Spinal fusion is a surgical procedure performed in the surgical department of the hospital under general anaesthesia. The patient is unconscious and pain-free throughout the procedure.
- The patient is positioned on the operating table, with monitoring devices in place to track vital signs during surgery. This allows the surgeon and anaesthesia provider to closely monitor the heart rate and blood pressure. The duration of the procedure can vary, but it generally takes several hours.
- The surgeon prepares the bone graft, which will be used to fuse two vertebrae together. If the patient’s own bone is used, a small section is taken from above the pelvic bone through a cut. Alternatively, synthetic bone or a bone from a bone bank (allograft) may be used as the graft material.
- An incision is made by the surgeon, depending on the location where the fusion will take place. For instance, for cervical fusion, a small incision is typically made in the horizontal fold of the front of the neck, exposing the cervical spine. The bone graft is then inserted between the affected vertebrae, either directly or using specialised cages. In some techniques, the graft material is placed over the back part of the spine.
- To provide additional stability and promote healing, the surgeon may employ internal fixation using plates, screws, and rods. These devices help prevent movement of the spine during the healing process.
- The muscles and tissues are repositioned, and the layers of skin around the incision are closed with stitches and sutures.
Spondylodesis surgery: How to prepare?
The preparation for spinal fusion typically follows the standard protocol for surgical procedures. It involves undergoing preoperative laboratory testing to ensure readiness for the surgery.
Before undergoing spinal fusion, it is important to inform the physician about any alcohol use, cigarette smoking habits, any existing illnesses, such as flu, colds, or herpes, and a list of all prescription and over-the-counter medications, as well as any supplements or herbs being taken. This allows the physician to provide specific instructions on how to manage these medications before and after the surgery.
Special instructions may be given for medications that affect blood clotting, such as anticoagulants (blood thinners) such as warfarin or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin.
To ensure a safe procedure, general anaesthesia is administered, requiring the patient to fast for a minimum of eight hours prior to the surgery. On the day of the procedure, the patient should only take the recommended medications with a small sip of water.
What to expect after the spinal fusion surgery?
After undergoing spinal fusion surgery, a period of recovery and observation in the hospital is necessary, typically lasting around three to four days. During this time, the doctor will monitor the patient’s reaction to the anaesthesia and surgery. The specific discharge date depends on the patient’s overall physical condition, the doctor’s practises, and the individual’s response to the procedure.
While in the hospital, the patient will receive pain medication and instructions on modified movements due to limited flexibility. New techniques for sitting, walking, and standing safely may be taught. Solid food intake may be restricted for a few days initially.
Upon leaving the hospital, a brace may be prescribed to maintain proper spinal alignment. The resumption of normal activities may be delayed until the bone has fused into place, a process that can take up to six weeks or longer. Physical rehabilitation may be recommended to strengthen the back and learn safe movement strategies.
Full recovery from spinal fusion typically takes three to six months, with the speed of healing and return to normal activities influenced by factors such as age, overall health, and physical condition. The patient should carefully follow the doctor’s instructions for self-care at home after the surgery, including proper back care.
Potential complications of the spinal fusion procedure
Spinal fusion surgery, like any surgical procedure, has potential complications that patients should be aware of. These complications can include:
- Infection: There is a risk of developing an infection at the surgical site or in the treated vertebrae.
- Blood clots: Blood clots can form in the legs, which can be dangerous if they travel to the lungs.
- Bleeding and blood loss: Surgery carries the risk of excessive bleeding, which may require additional medical intervention.
- Respiratory problems: There is a small risk of developing respiratory complications after surgery, such as difficulty breathing.
- Inadequate wound healing: Sometimes, the incision site may not heal properly, leading to delayed wound healing or wound-related issues.
- Reactions to medications or anaesthesia: Some individuals may have adverse reactions to medications or anaesthesia used during the surgery.
- Heart attack or stroke: Although rare, there is a small possibility of experiencing a heart attack or stroke during the surgery.
In addition to these complications, there are rare risks associated with spinal fusion, including:
- Increased stress on adjacent bones
- Damage to spinal nerves
- Discomfort caused by the implanted hardware
- Persistent pain at the bone graft site
It is important to note that the most serious complications, such as blood clots and infection, are more likely to occur within the first few weeks following the surgery. If you experience symptoms such as redness, swelling, drainage from the wound, calf pain, fever, shortness of breath, or groin pain, it is crucial to contact your doctor or seek emergency medical attention.
Prognosis (outlook) of Spinal Fusion Surgery
Spinal fusion is generally an effective treatment for specific spinal conditions. It takes time for the body to heal, and over several months, you can expect improvement in your symptoms and increased comfort as you regain strength and confidence in your movements. While the procedure may not completely eliminate chronic back pain, there is typically a reduction in overall pain.
It is important to note that spinal fusion alters the functioning of the spine by stabilising a specific area, which can lead to increased strain on the adjacent areas. This can result in pain and potential complications in those areas if they deteriorate.
Factors such as being overweight, leading a sedentary lifestyle, or having poor physical fitness can also contribute to further spinal problems. Therefore, adopting a healthy lifestyle that includes a balanced diet and regular exercise is crucial for achieving the best long-term outcomes.
By taking care of your overall health and following your healthcare provider’s guidance, you can optimise the outlook for your spinal fusion and minimise the risk of future complications.
Cost of Spinal Surgery in India
The actual cost depends on several factors, including the specific type of spinal fusion procedure, the age and medical condition of the patient, and the type of hospital accommodation chosen (such as an individual room or a shared room). It is essential to note that these estimates are rough approximations and may vary depending on individual circumstances and the healthcare provider.
The average cost of a spinal fusion surgery can vary between ₹80,000 and ₹2,00,000.
Takeaway
Spinal fusion is a complex surgical procedure that offers hope and relief to individuals suffering from debilitating spinal conditions. It involves fusing two or more vertebrae together to stabilise the spine and alleviate pain. Spinal fusion can be a life-changing solution for conditions such as herniated discs, spinal fractures, and degenerative disc disease. While spinal fusion can provide significant benefits, it is important to approach it with careful consideration and realistic expectations.
The procedure is not without risks, and the recovery process can be challenging and lengthy. However, with proper medical guidance, rehabilitation, and a commitment to post-operative care, many patients experience improved quality of life and reduced pain. It is crucial for individuals considering spinal fusion to have open and honest discussions with their healthcare providers, weighing the potential benefits against the risks. Each case is unique, and a thorough evaluation of medical history, symptoms, and diagnostic tests is necessary to determine the appropriateness of spinal fusion.
