Lumbar Spinal Fusion – Cervical Spinal Fusion

What is it

Spinal fusion is any surgical technique that aims to stabilize a part of the spine. This is achieved with the help of metal materials or implants that promote the bone unification of vertebrae that have been injured, deformed or have been displaced.

It is usually chosen in cases of spinal stenosis with instability, spondylolysis – spondylolisthesis, tumors or infections, scoliosis or kyphosis, cervical myelopathy, spinal metastases. The above diseases create deformations and instability of the spine, fractures, vertebral degeneration and definitely require surgical treatment.

Lumbar Spinal Fusion (Lumbar Spinal Fusion)

Lumbar spinal fusion is performed with appropriate implants which consist mainly of titanium and chromium cobalt alloys but also of special polymers which adapt perfectly to the body. These implants are called screws, rods and cages, respectively, and are the tools for the spine surgeon. With these, ossification or otherwise internal splinting of the spine is achieved.

Alternatively, (interbody) spinal fusion can be performed with anterior (ALIF) or lateral approach (XLIF), methods which in selected patients have comparative advantages.

It is important for the spine surgeon to know and be able to perform all interbody fusion methods with the same comfort and efficiency in order to choose the best one for the patient.

Neck fusion

Anterior cervical discectomy and fusion is the most frequently chosen procedure when pain in the neck and upper extremities persists and has been caused by degeneration (narrowing of the neural tube or foramina), trauma or a herniated intervertebral disc.

With this procedure, the entire disc is removed and replaced, usually with a cage (usually with a graft). The purpose of the surgery is to remove the disc and osteophytes that are pressing on the nerves and spinal cord, and to immobilize the intervertebral space so that there is no instability and pain is reduced.

In special cases, we can use a movable implant (artificial disc) to maintain movement.

Alternatively, spinal fusion can be performed through a posterior approach, similar to lumbar spinal fusion. In these cases, the decompression of the nerve elements is performed indirectly by removing the posterior elements of the spine (plateletectomy).

Spinal fusion options depend on the condition he intends to treat.

• Open method (classic): with a regular surgical incision in the center of the “waist” and placement of special materials under direct vision (cervical screws – transbody cages – stabilization rods, grafts).
• Minimally invasive method (MIS): all of the above are performed through surgical holes in the skin under the guidance of an fluoroscopic machine and with the use of special materials.
• Navigation-assisted spinal fusion: whether open or using minimally invasive methods, the correct use of intraoperative navigation can facilitate the placement of the transcervical screws and limit radiation exposure.
• Robotic-assisted spinal fusion: cutting-edge technology that combines intraoperative navigation and pre-selection of the optimal placement position of the materials by the surgeon, in order to minimize complications from improper placement. The direction of the preparation and placement of the materials is given by a robotic arm based on the data and information provided by the specialized surgeon.

Spinal fusion – Method selection criteria

1. number of vertebrae to be included in the spinal fusion
2. the degree of correction needed in case of coexisting deformity
3. cost
4. availability of auxiliary equipment and special materials

Lumbar spinal fusion – Cervical spinal fusion

Complications

The main complications of the surgical technique of spinal fusion are related to the improper placement of the implants, which is why digital navigation and robotic assistance are important aids in this direction. Neurological complications are rare. Whether a serious neurological complication will occur is also related to the part of the spine targeted by the spinal fusion.

Infection remains one of the most common complications, although its incidence has dropped dramatically with the use of antibiotics (approximately 1%). However, it is a treatable complication since it most often responds to the administration of antibiotics.

Spinal fusion – Duration of surgery and recovery

The duration of the operation depends on the extent of the spinal fusion. For a small spinal fusion with cages, the duration ranges from 2 to 3 hours. For a large spinal fusion with correction of deformity with osteotomies, the duration of the surgery can reach or even exceed 6 hours.

The surgical incision is checked at regular intervals during the first 2 weeks after surgery. The first examination is performed 6 weeks postoperatively. Subsequently, at 3, 6, 12 and 24 months.

The patient is mobilized immediately after surgery. The length of hospital stay depends on the extent of spinal fusion and the method chosen. It usually ranges from 1 to 5 days.

It is recommended to avoid weightlifting, bending and rotational movements of the waist for at least 6 weeks. Then, gentle exercise and muscle strengthening (swimming-light running on a treadmill) begin. After three months, gradual reintegration into a full physical activity program begins and usually after a year there is no restriction (even for contact sports).