Posts Tagged lumbar fusion
Spinal Fusion including Lumbar Fusion and Cervical Fusion for Pain and Nerve Compression in Houston, Katy, Woodlands, Sugarland, Memorial City, Texas Medical Center, TMC, Humble, Kingwood, Conroe and Beaumont
Bone fusion (also called arthrodesis) (when performed in the low back spine is called lumbar fusion, when performed in the neck is called cervical fusion) is the procedure by which bones are joined at specific joints, most often to alleviate pain. The new fused bones are allowed to grow together. This lowers pain levels because at common bone fusion sites (lumbar or lower spine, wrists, ankles, or thumbs, neck or cervical spine) there are often nerves nearby that are responsible for sensation, as well as recognition of joint position and movement. Bones on either side of the deteriorating joint can compress these nerves and cause extreme pain. Fusing these bones significantly lowers the incidence of nerve irritation, and when bone spurs are removed, can reduce nerve compression.
Causes for a patient desiring bone fusion surgery, or spinal fusion surgery can include rheumatoid arthritis and osteoarthritis, as well as severe back pain due to tumors or herniated (slipped) discs. Like other joints in the body, the discs (shock-absorbing pads) between our spinal vertebrae, can wear out. Nerve compression in the spine occurs much more frequently when these spinal discs have been thinned or ruptured by age and activity. The arthritis, as well as the chronic herniated discs, can compress nerves passing next to them. As in other regions of the body, bone fusion is a possible solution for reducing pain, but it will eliminate mobility at that particular joint.
Neurosurgeons at the Kraus Back and Neck Institute, in Houston, have a significant experience with utilizing spinal fusion (lumbar fusion, cervical fusion) to treat neck pain and low back pain in patients. They have offices located in Houston and surrounding areas of Katy, Woodlands, Sugarland, Memorial City, Texas Medical Center (TMC), Humble, Kingwood, Conroe, and Beaumont.
Bone fusion is somewhat unique in that in many cases, it seeks to mimic the body’s natural healing response. In one version, bone is taken from another region in the body and inserted between the two or more bones that are being fused together. This “foreign” bone stimulates bone growth during post-operative care, as it is placed under pressure and adjacent to other bone, which has been prepared to grow into the new bone graft. Other versions of bone fusion or spinal fusion may include implantation of wires, metal plates, screws, and other devices to accurately position the new joint, and keep it immobile, while the new bone is trying to grow into the bone graft. Adequate rest and physical therapy during post-operative care are absolutely essential to ensure that a proper bone fusion takes place. If the new joint is displaced by excessive movement, subsequent corrective surgeries may be necessary to re-set the bone.
The technique of lumbar fusion or cervical fusion (spinal fusion) can be performed in several ways. The general principle is to have bone grow across the currently mobile disc space. A number of techniques are possible. One approach is to try to achieve this fusion on the sides of the spine, between what are known as transverse processes, which project outward from the vertebral bodies. In doing so, the surgeon exposes these transverse processes during the operation, and removes the outer coating of the bone, known as the cortex, thus exposing the inner cancellous bone, which is the honeycomb type of bone seen when one breaks open a chicken bone. With the outer hard cortex removed, the inner cancellous bone will attempt to grow into the bone graft which it is in contact with. This bone graft can be placed on the side of the spine, which is known as a lumbar posterolateral fusion. It can also be placed between the vertebral bodies, which is known as an interbody fusion. When this type of lumbar fusion is performed, it is called a lumbar intervertebral body fusion. When this type of cervical fusion is performed, it is called a an anterior cervical discectomy and fusion (ACDF). In the cervical spine, this type of fusion is generally performed through an anterior approach, which means going in through the front of the neck. When this interbody fusion is performed in the lumbar spine, it can be performed from the back of the spine (known as a PLIF (posterior lumbar interbody fusion) or a TLIF (transverse lumber interbody fusion), the front of the spine (known as an ALIF (anterior lumbar interbody fusion). It can also be performed from the side of the spine, known as an XLIF (extreme lateral interbody fusion) or a DLIF (direct lateral interbody fusion) (these different names utilized basically the same lateral approach, but were given different names by two different manufacturers of the spinal hardware equipment (Nuvasive and Medtronic). It can also be performed through an approach going straight up the spine, through an incision made next to the tail bone, known as an AXIALIF (axial lumbar interbody fusion), the instruments of which are manufactured by TranS1.
There are also a number of different grafts which can be used for promoting the bone growth in a spinal fusion. Cadaver bone can be used, which is harvested from cadavers. This is known as allograft. Bone can be taken from the patient undergoing surgery, either from a different site or from the same site. This is known as autograft. Substances known as bone morphogenic protein (BMP) ( Medtronic manufactures Infuse) can be used locally to promote bone growth. Stem cells, taken from the patient’s own blood which has been spun down in a centrifuge, can be placed over the graft to help promote bone growth.
Candidates for bone fusion / spinal fusion also need to be aware of the effects of smoking on the procedure. Osteoblasts (bone-growing cells) are needed in droves to ensure a speedy recovery. One of the addictive chemicals in cigarettes, nicotine, is toxic to osteoblasts and can substantially lengthen the time necessary for a complete bone fusion, or even make it impossible to achieve. Smokers are advised to abstain before and after the procedure.
Patients suffering pain in the neck, low back, or other portions of the spine, can call the Kraus Back and Neck Institute in Houston, TX. They will be evaluated and appropriate tests will be ordered. No imaging studies are required for patients to be seen.
Key Words: spinal fusion, lumbar fusion, cervical fusion, nerve compression, pain, Houston, katy, woodlands, sugarland, memorial city, texas medical center, TMC, humble, kingwood, Conroe, beaumont