Obtaining a solid spine fusion
Once the decision to proceed with surgery has been made, then obtaining
a solid fusion is the next task. Some of the factors that relate to the
spine fusion healing have to do with the patient (host factors), and
some with the technique of the spine surgeon.
Host factors that negatively impact on obtaining a spine fusion
surgery include:
Of all these factors, the one that most negatively impacts the fusion
rate and is under the control of the patient is smoking. Nicotine
has been shown to be a bone toxin and it inhibits the ability of the
bone growing cells (osteoblasts) to grow bone. A fusion is basically
a race between the bone growing cells and the bone eating cells (osteoclasts).
Continuing to smoke after a spine fusion surgery, especially immediately
after surgery, favors the bone eating cells and significantly undermines
the fusion process. Since almost all fusion procedures for back pain
are elective, it only makes sense for patients to make a concerted effort
to quit smoking to give the best chance possible of allowing the bone
to heal. Quitting smoking is difficult but also definitely worth it when
considering a lumbar fusion surgery.
Surgical techniques for spine fusion
Technically, there are a lot of surgical procedures that can be done to fuse
the spine. The spine fusion surgery can be done:
From the front (anterior lumbar interbody fusion/ALIF) (figure
1, figure
2)
-
from the back (posterior lumbar interbody
fusion/PLIF or posterolateral gutter) (figure
3, figure
4)
-
from both front and back (anterior/posterior)
With any type of spine surgery, the specific
technique used is largely dependent on the spine
surgeon’s experience and his or her comfort
level with the approach.
There has been a recent trend in spine surgery
toward trying to do more minimally invasive types
of procedures. Anterior fusions – approached
from the front – are done through a laproscope
or a mini-open incision and carry less morbidity
(unwanted aftereffects) than spine fusion surgery
done through a posterior incision.
Some types of pathology do not lend themselves
well to an anterior fusion alone, and not all
spine surgeons are comfortable with the approach
or do not believe it is the best approach. No
matter how the spine fusion surgery is done,
the goal is to obtain a solid fusion and stop
the motion at the level fused. |
