Spinal fusion

The medical term Spinal fusion describes a operative spinal stiffening. In this surgical procedure, two vertebrae are stiffened together. The resulting loss of movement remains permanent and cannot be reversed.

What is spinal fusion?

Spondylodesis is an invasive form of therapy for certain forms of severe back pain and changes in the spine. Surgical stiffening of the spine is carried out either partially or completely, depending on the indication. The extent of the stiffening determines the later mobility between the vertebrae. Since several vertebral bodies are connected with the help of plates or screws during spinal fusion, these can no longer perform their joint function.

Spinal stiffening is a very complex and large operation on the back. After the procedure, it is no longer possible to improve the body's statics. Due to the irreparable result, this form of therapy often represents the patient's last chance to improve the symptoms. Therefore, in almost all cases, a stiffening operation is only performed if neither conservative treatment measures such as physiotherapy, manual therapy, muscle building training or back training, nor other measures such as injections and medication have not been able to bring about an acceptable improvement in the symptoms.

Function, effect & goals

Spinal fusion is performed because of serious spinal diseases. The stiffener can be used in the case of pronounced scoliosis or serious spinal injuries after an accident as well as in the case of severe breakdown of the bone structures. Even if the vertebrae fracture, the stiffener brings the vertebrae together again.

The spinal fusion ensures that the stability of the spine is maintained. In addition, important structures such as the spinal cord and aorta are protected. The endangerment of internal organs can also be averted by a stiffening. In this way, not only pain disorders but also neurological deficits can be treated.

Surgical stiffening of the spine always takes place under general anesthesia. Only if no implants need to be inserted can the spondylodesis be performed in a minimally invasive manner. This method ensures that both skin and soft tissues are minimally injured upon access. The use of the special instruments is controlled via imaging procedures during the operation.

The invasive surgical technique itself is carried out from the back, with the back muscles being pushed to the side. This access allows the surgeon to access the vertebral bodies that are to be stiffened. Titanium screws are used here, which are connected to longitudinal bars. Bone ablation is done when nerve roots become narrowed by the vertebrae. In order to maintain the bony stiffening, bone structures are attached to the so-called transverse processes. The bone mass required for this is taken from the back of the iliac crest. In some patients it is necessary that metal cups be placed in the vertebral space where the intervertebral disc is in contact with bone. Both screws and rods ultimately cause the bones to grow together permanently. Subsequent metal removal can largely be dispensed with.

The duration of the operation depends on the extent of the spinal stiffening. If the duration of a minimally invasive interlocking is sometimes less than an hour, a long spondylodesis can take up to several hours. Nowadays, the goal of stiffening is achieved in over 95% of all cases. Using the most modern surgical techniques such as bone apposition and screw fixation, a successful fusion of the vertebrae can almost always be ensured.

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Risks, side effects & dangers

Since the spinal fusion is in most cases a very large procedure, there are risks for the cardiovascular system on the one hand. On the other hand, wound infection occurs in around one percent of those who have been operated on. In principle, complications are rare. Nevertheless, nerve injuries can occur, as in most cases constricted nerve fibers have to be exposed as part of a stiffening process.

Damage to the nerves in the spinal cord can have serious consequences: sensory disturbances and impairment of motor skills are possible. However, the screws used only rarely affect the nerve roots. If damage does occur, the nerve usually recovers completely after a while. However, there is still a minimal risk of developing permanent foot or leg weakness. The risk of full body paralysis can be excluded. It is nearly impossible for patients to be confined to a wheelchair after undergoing a lower back spinal fusion.

It happens that the vertebrae do not grow together sufficiently. The screws can then loosen and cause pain again. Heavy smokers in particular are more likely to be affected by this complication. In addition, it is possible that implant damage such as material breakage occurs during or after the stiffening. To fix these problems, the spine must be operated on again. Since the operated patients are only allowed to move inadequately within the first eight weeks after the operation, the risk of developing a thrombosis is increased. A urinary tract infection can also occur when the necessary urinary catheter is used.

After the operation, patients often complain of back pain. These are caused by the procedure itself, as tissue structures are damaged. In addition, there are uncomfortable wound healing pain. With a spinal fusion, the surgeon makes a very long incision. If the scar heals poorly, adhesions or growths may occur. These can cause discomfort in the long term. This is different with a minimally invasive procedure, in which only small wounds occur.