Spinal Fusion, Instrumentation, and Reconstruction

The surgeons in the Department of Neurosurgery perform all types of spinal fusions. The ability to safely and successfully perform such procedures requires an intimate understanding of spinal anatomy and spinal disease. A true understanding of the limitations of such treatment is also necessary to minimize the frequency of failed operations.

Spinal fusion and reconstruction may be necessary for a great variety of reasons, including disc herniations, traumatic spinal injuries, congenital and degenerative spinal conditions, and for removal of tumors. These conditions may cause you pain and neurological injuries, but they can often be treated successfully.

To “fuse” bones ordinarily requires bone to be placed between two separate pieces of bone. These bones then grow together to form one solid structure. In the spine, typically two vertebra are fused together either by placing bone in the space where the disc normally resides or by placing bone along other parts of the vertebra. “Spinal instrumentation” refers to the metal objects placed in the spine to immediately help increase the strength of your spine and to increase the likelihood that a spinal fusion will be successful. This may include the use of metal plates, rods, screws, hooks, or wires, all of which are usually made of titanium.

Fusions are often performed following surgery on disc herniations in the cervical spine. The common procedure, known as “anterior cervical discectomy and fusion,” involves not only removing the herniated disc, but also performing a fusion in the area formerly occupied by the disc. Often, cervical instrumentation is added to help the fusion occur more quickly and successfully. These procedures are less common in the thoracic and lumbar spine for disc herniations, but when appropriate, can dramatically help reduce the pain of certain disc diseases.

Conditions such as spondylolisthesis, in which one vertebra slips forward on another, can result in pain and neurological deficits. This most commonly occurs in the lumbar spine, the lowest part of the back. When the symptoms are severe enough to require surgery, decompression, fusion, and the addition of spinal instrumentation may be required to try to relieve your pain and restore strength to the spine.

Motor vehicle accidents are the most common cause of severe spinal trauma. This trauma may be limited to the bony spine, in which you will have full use of your arms and legs and no spinal cord injury, or your spinal cord may also be injured. A severe injury to the spinal cord in your neck will typically result in you becoming quadriplegic, meaning you will have no movement or sensation in your legs and little or no movement or sensation in your arms. Injuries to the spinal cord below your neck will typically spare your arms, but cause loss of sensation and strength in your legs.

Currently, there is no curative treatments for spinal cord injuries. Medical and supportive therapy can try to limit the injury and allow your body to heal, but neurological injuries are often permanent. Associated bony injuries, however, are aggressively treated. Usually, the trauma will have broken the spine or weakened the integrity of the spine, making it dangerous for you to move or begin rehabilitation due to the risk of causing further injury. In these cases, spinal fusion with instrumentation is commonly used to restore strength to your spine and allow rehabilitation to begin. Often, you will need a brace for a period of time following surgery to afford the best chance for the injuries to heal. Aggressive rehabilitation can then begin, which will allow you to regain as much independence as possible.


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