Common Questions
About Spine Surgeries
- Severe post operative peri-neural scarring or severe arachnoiditis.
- Previous bilateral transforaminal approach with root fibrosis.
- Large dural tears and equina root herniations.
Likelihood of fusion is increased with good stability of the bones that need to be fused. Axial compression stability is added anterior by use of the cage that is placed via the Trans foraminal L1-5 and the PLIFapproach L5-S1. Rotation, side bending and flexion extension stability is created by posterior pedicle fixation segmentally over the vertebra that requires fusion. The pedicle fixation is placed under compression, forces to enhance stability further.
Mechanical instability of the spine may result from a several causes, including degenerative disease, trauma, or cancer. If the degree of instability is excessive the structural integrity of the spine will be compromised. This decreased stability can produced pain during normal activities, a condition known as mechanical low back pain. The pain is typically confined to the lower back, hips, and thighs. If a significant degree of instability exists or conservative measures fail, the structural integrity of the spine is restored through a spinal stabilization surgery. The operative procedure, known as a fusion and fixation, is intended to eliminate the movement across the unstable portion of the spine and reduce the production of pain. Long-term stability is achieved through the growth of a bony bridge between the unstable bones, known as a fusion.
With normal aging the discs gradually collapse, the facet joints thicken and ligaments lose their elasticity and stabilizing ability. These various gradual changes in the spine lead to a loss of space for the nerve elements (spinal stenosis) since degeneration has a tendency to lead to settling between vertebrae (sometimes also shifting, such as in spondylolisthesis) and thereby narrowing of the spinal canal and neuroforamen at the affected levels (usually lower lumbar spine).
If you do not have an operation, your pain is likely to continue and may get worse over time. If you have weakness or numbness, this may also get worse.
If you have numbness and weakness (neurological symptoms) or difficulties passing or controlling your urine, you should have an operation.
The procedure is performed under general anesthesia. A midline incision is made in the lower back overlying the area of instability. Soft tissue is dissected off the back of the spine to expose the unstable spinal segments. A lumbar laminectomy is typically performed to decompress the neural elements. Once the neural elements are free, the spinal stabilization procedure is performed. The bone to create the fusion is harvested from the iliac crest (a part of the hip bone) through the same or separate incision. Using bony landmarks & fluoroscopy the entry site and trajectory of the pedicle screws is identified and the screws are inserted. These advanced imaging techniques allow more accurate screw insertion. The harvested bone is then transplanted across the unstable spinal segments. The pedicle screws are then connected with metallic rods providing immediate stability. The operative site is then sutured closed in multiple layers.
- Excessive bleeding causing shock,
- Injury to the dura causing cerebrospinal fluid leakage or meningitis.
- Delayed wound bleeding, haematoma formation and wound infection.
- Problems in wound healing or persistent scar discomfort.
- Loosening or breakage of internal fixation device.
- Failure of bone union.
- Problems with iliac crest bone graft donor site such as wound infection,
- Recurrence or deterioration of the original spine condition.
Region specific
A. Cervical spine surgery
- Injury to the vertebral artery causing stroke.
- Injury to the cervical cord or nerves causing neurological damage, in extreme case may lead to tetraplegia, double incontinence and breathing difficulty
B. Thoracic spine surgery
- Injury to the lung causing pneumonia or pneumothorax.
- Injury to the thoracic cord or nerves causing neurological damage, in extreme case may lead to paraplegia, double incontinence and breathing difficulty
C. Lumbosacral spine surgery.
- Reflex slowing of bowel movement causing abdominal distension and vomiting.
- Injury to the spinal nerves causing neurological damage, in extreme case may lead to paraplegia and double incontinence.
The recovery period varies from case to case but on average is 6-12 weeks. Most patients are usually able to go home 3-5 days after surgery. Before patients go home, physical therapists and occupational therapists work with patients and instruct them on proper techniques of getting in and out of bed and walking independently. Patients are instructed to avoid bending at the waist, lifting (more than five pounds), and twisting in the early postoperative period (first 2-4 weeks) to avoid a strain injury. Patients can gradually begin to bend, twist, and lift after 4-6 weeks as the pain subsides and the back muscles get stronger. During this time we encourage people to walk as much as possible, lie as much as possible but to only sit for limited periods (20-30 minutes). Walking, swimming, aerobic classes are all very suitable only after doctors permission but please avoid contact sports,
Brace
Patients are issued a soft or rigid lumbar corset that can provide additional lumbar support in the early postoperative period, if necessary.
Wound Care
The wound area should remain covered with a gauze bandage secured in place with tape. The area should be kept clean and dry. The bandage should generally be changed every 7 days.
Shower / Bath
Body sponging to be preferred for initial 10-15 days till stitch removal. But if patient wish to take bath than , keep the incision area covered with a bandage and tape, and try to avoid the water from water hitting directly over the surgical area.
Driving
Patients are refrain from driving for 4-6 weeks, longer if still in pain after surgery.
Return to Work and Sports
Patients may return to light work duties as early as 2-3 weeks after surgery, depending on when the surgical pain has subsided. Patients may return to moderate level work and light recreational sports as early as 3 months after surgery, if the surgical pain has subsided and the back strength has returned appropriately with physical therapy. Patients who have undergone a fusion at only one level may return to heavy lifting and sports activities when the surgical pain has subsided and the back strength has returned appropriately with physical therapy. Patients who have undergone a fusion at two or more levels are generally recommended to avoid heavy lifting, laborious work, and impact sports.
Doctor’s Visits and Follow-Up
Patients will return for a follow-up visit to see the doctor approximately 12-14 days after surgery. The incision will be inspected. The incision will be inspected and the stitches or staples will be removed.
Conservative treatment including physiotherapy and occupational therapy Physiotherapy or osteopathy can help reduce back pain, but does not usually reduce leg pain or weakness. Result depends on individual patient and disease