Spinal Fusion in India

Spine fusion is a typical surgery that involves the permanent fusion of two or more vertebras (small bones in the spine), forming a single solid bone that provides structural stability to the spine and relieves the painful movements of the spine. Spine fusion surgery is indicated for various problems, viz. fractured vertebra, degenerative disk disease, herniated disk, infections, spinal stenosis (narrowing of the inside spine space), spinal weakness, tumours, scoliosis (sideway curvature of the spine), kyphosis (outward curvature of the spine), spondylolisthesis (displacement of vertebras), etc. Spinal fusion can be performed in cervical, thoracic, or lumbar regions.

Alternate Name

Arthrodesis or Spondylosyndesis or spondylodesis

Body Location

Spine vertebras

Preparation

During spinal surgery, like any other surgical operation, you will undergo certain blood tests such as CBC (complete blood count), bleeding test, clotting test, etc. You will be referred for a pre-anaesthesia check-up (PAC), including a chest X-ray and electrocardiogram (ECG), to mark you fit for the surgery. You will also be required to take certain imaging tests, such as an MRI scan or CT scan, as your surgeon will confirm the diagnosis, mark the location, and plan the procedure.

You should inform your doctor about your current medical conditions and past medical history, and any medication that you are taking. You will be asked to discontinue blood thinning medications such as warfarin or aspirin to avoid the risk of bleeding. You should stop drinking and smoking, as these could hinder the healing process.

On the day before the operation, you should not drink or eat anything after midnight; otherwise, it can complicate anaesthesia. You will be kept under observation for a few hours before the surgery, so you should reach the hospital at least 4-6 hours before the scheduled time.

How Performed

Spinal fusion is carried out under general anaesthesia, and you will be asleep throughout the procedure, unable to feel any pain or sensation. Depending upon the surgeon’s discretion and the vertebra involved, you may undergo anterior (spine accessed from the front), posterior (spine accessed from the back), or lateral (spine accessed from either side) surgery. A bone graft will be used to fuse the vertebras, and it could be taken from your pelvic bone, from a bone bank, or a synthetic material could be used.

The surgeon will make a small incision at the site where fusion is to be made and will access the vertebras. In a minimally invasive procedure, the surgeon will use the camera to monitor the surgery from a computer and target the specific bones/tissues without disturbing other organs, bones, and tissues. The bone graft will be placed between the vertebras for stimulation of fusion, and the surgeon will use screws, plates, cages, or rods to hold the bones together for enhanced stability and a better success rate. In some cases, self-dissolving screws are used. The incisions will be stitched afterward.

Procedure Type

Minimally invasive

Follow-up

You will be given a follow-up schedule, and you should follow up with your surgeon as per the plan to ensure a good recovery. You might also be undergoing MRI scans at certain follow-ups after the surgery as your surgeon will assess the recovery progress. You might also be advised to undergo physiotherapy for a few weeks to restore your movements and help you gain flexibility.

You should start with light physical activity, such as walking, as suggested by your doctor. Avoid heavy activities such as cycling, running, jogging, lifting weights, etc., that could strain your spine. Good night's sleep and proper rest are crucial for a speedy recovery. While you recover, do not overexert yourself and seek help from friends and family members to perform your daily chores. Avoid long drives and driving for a few months, and if you must, discuss it with your surgeon. Keep the incisions clean by using soap and water to clean the stitches and gently dry tap the incisions. Avoid getting into a bathtub or pool as you might slip and hurt your back and also it could lead to infection at the incision site.

Risks

Although minimally invasive spine fusion is more efficient and safer than traditional open spine surgery; however, it is also associated with the following risks:

• Incision site infections could occur, and you might require antibiotic treatment.
• Bleeding at the incision site could occur in the case of complex procedures.
• Blood clot formation could occur.
• Hypersensitivity to anaesthesia could occur in sensitive individuals.
• Damage to the adjoining or nearby organs/tissues/nerves could lead to other painful conditions or loss of sensitivity.
• In some cases, symptoms could recur due to certain reasons, such as overall spine weakness or instability.
• Pseudarthrosis could occur due to incomplete bone fusion, and individuals with diabetes, tobacco use, smoking, advanced age, etc., are more prone to develop it.
• Draining from wounds could also occur in some cases; hence, incision care is required.

Recovery

After the surgery, you will be under intense monitoring for a couple of hours to days, depending upon the complexity of the surgery and your overall health status. You will be discharged within a few days from the hospital once you have stable parameters. Training will be given to you for moving, standing, sitting, and walking so that you don’t put pressure on your back. You will be trained in the leg-roll technique to get out of bed. Keep in mind that you need to move the entire body in one go so that you don’t end up twisting your spine.

The complete recovery may take a few months, and while you return to your routine activities, you need to take good care of your back and spine. Wear your braces or back support belts as recommended by your doctor for the specified duration. You should not indulge in any heavy activity for a few weeks and must discuss with your doctor if your job requires lifting heavy weights, excessive bending, or strenuous physical activity.