Types of Spinal fusion surgery
Part of spine- Spinal fusion can be done at any location of spine
- Lumbar fusion- commonly done procedure mainly due to degenerative disc changes in lumbar spine which causes pressure on the spinal cord nerves
- Cervical fusion- also commonly performed due to increased motion and stress on cervical spine.
- Thoracic fusion –thoracic spine being more immobile, so usually the cause of fusion in thoracic spine is trauma or deformities.
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Multi levels of spinal fusion
- One level spinal fusion– used to stop motion at one segment eg L4-L5, two vertebra need to be joined together to stop motion at one segment.
- Two level spinal fusion used to stop motion at two segments L4-L5, L5-S1, that is it involves joining of three vertebra , however spinal fusion of 2 or more levels is unlikely to provide pain relief as hampers normal motion of back and puts stress across remaining joints.
- Fusion of 3 or more levels is not done except in cases of scoliosis or deformity.
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Procedure of spinal fusion surgery
A complete health check up and diagnostic tests done before surgery ,it involves a series of blood tests , ECG , X ray and scans.Some medications like blood thinners need to be stopped atleast 2 weeks before surgery .It is important to quit smoking as it decreases blood circulation and hampers bone fusion.
Step 1-The patient is positioned and anaethesia given
Step2- Incision is made in skin and tissues are gently moved aside to create a path to spine Minimally invasive techniques have also been developed these allow fusions with small incisions.
The procedure may be done by different techniques depending on the best possible for the patient and expertise of the surgeon
In lumbar spinal fusion different techniques may be
Posterolateral fusion – in this technique the bone graft is placed in between the transverse process and the vertebra are then fixed in place .
Interbody fusion -In this technique entire intervertebral disc is removed and bone graft is placed in space between the vertebra, types of interbody fusion
- Anterior lumbar interbody fusion(ALIF)- this procedure is performed from the front with an incision in lower abdomen, intervertebral disc is removed and bone graft placed .
- Posterior lumbar interbody fusion (PLIF)- as the name suggests this procedure is performed through the back and also includes removing the disc and inserting bone between two vertebrae.
- Transforaminal lumbar interbody fusion (TLIF)-this procedure is also performed from the back
- Oblique lateral lumbar interbody fusion (OLLIF)- the surgeon may approach the spine from the side.
Step 3- Bone grafting is done – For fusion to occur between two vertebra a bone graft is needed to serve as bridge, generally bone grafts are placed into the space between the vertebrae to be fused .Bone graft helps bone healing and also increases bone production.
The graft used may be
- Allograft – from bone bank / cadaver
- Autograft- usually a piece of bone from around patients own pelvis
- Artificial -Synthetic bone substitute may be used
Step 4-Immobilization-The bone graft and vertebrae must be immobilized while the bone graft heals and fuses .The fusion area is immobilsed and held together with metal rods , screws or cages
Step 5-Incision is then closed , a brace may be prescribed to support the spine
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You will be monitored in the hospital for 2-3 days , maybe required to wear a brace while you recover.You will feel some pain after surgery which will be controlled by medications
Bed rest is usually not needed .Rehabilitation may take time and may be several months before the bone is solid .
While the healing is ongoing the fused spine must be kept in proper posture. You will be instructed the correct manner to sit , stand and walk so as to not hamper the fusing process.
After 3-6 months after surgery , the bone graft should join the vertebra above and below to form one solid piece of bone that securely attaches to the spine creating permanent fusion , gradually improving your symptoms and also your activity level.
Diagnostic Tests for Spinal Fusion surgery
- Usually complete symptomatic history of patient taken ,clinical examination Imaging techniques done to confirm diagnosis and also to rule out other problems
- MRI is performed to look for disc problems and check spinal nerves status
- CT Scan for ruling out joints and bones problems
- X-ray to check for arthritis or injuries in vertebrae
- Bone scan to rule out cancer
- Myelogram, electromyogram
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Factors affecting cost of Spinal fusion Surgery
The cost to the patient depends on a variety of factors like
- The hospital, the patient chooses.
- Room –Standard single room, deluxe room, super deluxe room for the number of nights specified (including nursing fee, meals, room rate, and room service).
- Fee for the team of doctors.
- Standard test and diagnostic procedures.
- Cost of the follow –up care required after the procedure