Surgical principles for a spinal fusion

• The principle of spinal fusion
• Bony fusion

The operation of the spinal fusion

A stiffening operation / Spinal fusion of the Lumbar spine can in principle be performed from the front, over the abdomen, from behind, over the back or from both sides simultaneously or in two chronologically separated operations. In the field of Cervical spine the usual procedure is a stiffening operation from the front.

Various techniques and materials are available with which a spinal fusion surgery can be performed. This cannot be discussed in detail. Such detailed knowledge is also of no interest to the layperson.

So-called dynamic spinal fusion implants have also been available for some time, to which one topic is dedicated.

The principle of spinal fusion

Using various surgical techniques and materials (implants), a section of the spinal column established before the operation of the spondylodesis is stabilized. The actual stiffening, in the sense of a bony fusion of a section of the spine, is the task of the body and takes place in the following months after a Spinal fusion surgery instead of the stabilized sections of the spine fusing with one another.

stabilization

In spinal fusion, a section of the spine is stabilized mostly by inserting screws and rods from the back. Displaced vertebral bodies can be set up beforehand, vertebral canal constrictions and constrictions in the area of ​​the nerve exit holes (neuroforamen) are eliminated beforehand (decompression). The screws are inserted into the vertebral body through part of the vertebra (pedicle). Two screws are inserted per vertebral body. These screws are then connected to one another via bars in the longitudinal and, in some cases, also in the transverse direction.

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Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
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The spine is difficult to treat. On the one hand it is exposed to high mechanical loads, on the other hand it has great mobility.

The treatment of the spine (e.g. herniated disc, facet syndrome, foramen stenosis, etc.) therefore requires a lot of experience.
I focus on a wide variety of diseases of the spine.
The aim of any treatment is treatment without surgery.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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Bony fusion

This o.g. Procedure alone is usually not sufficient for spinal fusion surgery because the Vertebral bodies by this sole measure have no possibility of growing together bones. For this it is necessary the Band washers to remove and replace on the stiffening section. Bone blocks can be used as a substitute Pelvic bones can be removed from the patient (Iliac crest chip). They are introduced into the previously cleared intervertebral disc spaces and can grow together with the adjacent vertebral bodies. Alternatively you can metal cups (Cages) are introduced into the intervertebral disc spaces, which are filled with growth bones (Cancellous bone (Sponge bone)) were previously filled. Smaller cups can be inserted from the back during the operation, larger cups must be inserted from the abdomen.

When a complete vertebral body replacement is required, e.g. In the case of a destructive infection or a serious tumor disease, special implants (vertebral body replacement implants) are available.

Complications of spinal fusion

Spinal fusion is not a small operation. Serious complications are possible, but not the norm.

To the Early complications counting:

• Infection, wound healing disorder
• Thrombosis / pulmonary embolism
• Secondary bleeding
• Nerve injuries / paralysis / sensory disturbances
• Intestinal paralysis (in the case of surgery from the abdomen)

To the Late complications counting:

• Pseudarthrosis (failure of the osseous fusion and persistence of painful, pathological instability)
• Connection instability (beginning of an overload-related, painful vertebral body instability at the transition from the stiffened spinal column section to the left, flexible spinal column section).
• Subsequent degeneration (painful wear and tear of the intervertebral discs and other vertebral parts at the transition from the stiffened spinal column to the left spinal column).
• Screw and metal breakage or loosening