Purpose of Procedure
The primary purpose of this procedure
is to stabilize the spine (stop the motion) by restoring the disc height and alignment
with metal cages and fusing the vertebra together
using the patient's own bone or a genetically engineered substance
known as Bone Morphogenetic Protein (BMP).
Bone for Fusion
There are currently two primary
alternative sources for the bone needed for the spinal fusion.
Traditionally, some of the patient's own bone has been harvested from
the iliac crest (pelvic bone). This technique produces excellent
results for the fusion.
Early in 2003, the FDA approved a
genetically engineered bone substitute for use in spinal fusions.
Under the brand name, InFUSE, BMP converts stem cells into bone
forming cells and stimulates rapid growth of bone at the targeted
site. Using BMP eliminates the need for harvesting the patient's own
bone and speeds up the fusion process.
Using either form of bone graft can
yield a high rate of fusion, but neither is 100 %. BMP has tended to
give better rates of fusion than other graft materials, including
pelvic bone.
What are the cages
made of?
Metal cages are usually made of
titanium. Newer cages are being made of carbon fiber and special
inert synthetic compounds. These do not set off airport screening
detectors.
Posterior (Back) Approach Disadvantages
Substantial retraction
of the nerve roots is necessary for the surgeon to gain access to the
disc space. Significant traction can injure the nerve root and has the
potential to result in chronic leg and back pain. The pain associated
with this type of nerve root injury can be severe, and there are no
effective options for treatment.
There are numerous
veins (epidural veins) over the disc space, and surgery in this area
creates the potential for excessive blood loss during the surgery.
This very rarely occurs.
Who will be involved
in procedure?
Surgeon
- The orthopedic spine surgeon that you have been seeing in our office
will be the primary surgeon, in charge of your surgery.
Vascular Surgeon/co-surgeon
Assistant Surgeon
- Another orthopedic spine surgeon, usually from our office, will
assist your orthopedic surgeon with the procedure. This is done to
minimize the length of time you are under general anesthesia and to
provide the necessary assistance with the actual surgical procedure.
Anesthesiologist
- The doctor who actually administers and monitors the anesthesia is a
critical part of the surgical team. You will normally meet with the
Anesthesiologist during your Pre Op appointment at the hospital.
Length of Surgery
One to two hours are
typical for one or two-level fusion procedure.
Hospital Stay
With most spinal
surgeries, patients are up and walking within hours after their
procedure. It is no longer necessary, or recommended, that you lie in
bed for days or weeks after spine surgery. Nurses who are experienced
in working with spinal surgery patients will assist you during your
first few efforts at getting out of bed and walking.
Your doctor will
tell you when it is safe to shower after surgery. Showers are usually
allowed 2-3 days after surgery. Soaking in a bathtub is not
allowed.
Incision Care
The nursing staff
at the hospital will show you how to keep the dressing dry and in
place to protect the incision while showering. The wound should not be
submerged in water (pool or tub) until it has healed and has been
cleared by your doctor. The nurse will change the dressing after your
shower, and again later if necessary.
Your surgical incision will be checked
during your first Post Op appointment. However, should your incision
become red and tender or drainage occur, prior to your first scheduled
Post Op visit, you should contact our office for instructions.
Nutrition
Liquids are allowed right
after surgery. Solid foods are not started for several days. Your doctor will give you specific instructions.
How much pain should
I expect and how is it treated?
Your doctor's goal is to keep you as
comfortable as possible. Almost all strong pain medications are
narcotics that tend to make you sleepy and can depress your breathing.
We must balance the side effects with our goal to relieve pain. In
the hospital (IV) patient controlled medications are given the first
day. We then switch to oral medications. You will have pain pills
for home use, also. We continue home medications as needed, with the
goal of weaning them as you recover. It is important to tell your
doctor of any allergies to medicines and to only use pain medications
as directed. Mixing medications can be dangerous. We do not
refill pain medications after hours or on weekends. You must ask
ahead 1-2 days if you are going to run out of pain pills. Refills of
medications are at your doctor's discretion.
Return to Routine of
Normal Daily Living
It normally takes approximately 3 to 6
months for the fusion to occur. During that time you should avoid
strenuous activities that might affect the fusion process.
During the rehabilitation process it
is important to recondition the muscles with exercise, stretching and
aerobic conditioning. Your doctor will give more specific
instructions during the course of your post-operative care during your
office visits.
Driving is not allowed until after
your first post-op visit (Usually 7-10 days). Most patients are able
to go up and down stairs when they go home from the hospital. Some
patients may require additional assistance.
Return to Work
Return to work is determined for each
individual patient based upon several factors. The doctor's goal is
to help you return to work as soon as you can do so safely. If you
have a light or sedentary job or if light duty restrictions are
available, then return to work could occur in 10-14 days. If you are
able to work from home by phone, fax and computer, very early work may
be realistic. If your job is very heavy and strenuous, return to work
can take several months. Other factors that play a role in return
include your overall physical condition, tolerance of pain and need
for additional therapy.
Even the best results of surgery do
not mean that you will necessarily be able to return to your prior
type of job. Some patients are advised to go through job re-education
or find a lighter job for future back safety.
Return to Work
It normally takes approximately 3 months for the fusion to occur.
During that time you should avoid strenuous activities that might
affect the fusion process.
During the rehabilitation process it is important to recondition the
muscles with exercises, stretching and aerobic conditioning.
Risks and Potential
Complications
