Spinal Fusion for Sciatica – A More Common Surgical Alternative For Recurring Sciatica

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Treating Sciatica with Spinal Fusion

Long-term sciatica may be resulted from spinal dysfunction such as the narrowing of the vertebrae, more known as spinal stenosis in medical world, and osteoporosis or loss of bone mass over time. Externally induced spinal fractures may also lead to persistent occurrence of lower back and buttock pains, pins and needles or tingling sensation on the lower limbs and, even numbness on the thighs and feet – all signs of sciatica!

While short-term sciatic pains are usually treatable by conventionally non-surgical methods such as reflexology, physiotherapy and chiropractic, recurring sciatica is usually traced back to permanent damage in the spine, of which surgery is the only effective cure.

There are several types of surgical procedures used to permanently ease off patients from sciatic symptoms. Which type applied completely depends on the kind of damage the spine experiences, recommendations by surgical specialist and patients’ preferred choice. Out of all surgical procedures known to significantly reduce sciatica—laminectomy, discectomy, vertebroplasty, kyphoplasty and DSR, or disc replacement surgery—spinal fusion has become more popular, especially in the US, for the past 10 years or so.This is because spinal fusion patients are given more options as to the surgical technology they may choose from. We shall discuss some of these options in a while, but at the meantime, let’s learn more about what spinal fusion actually is.

What is spinal fusion?

Spinal fusion literally means the fusion or joining of two or more parts of the spine. Just like casts and screws are used to align and support fractured arms or legs, fusion of the vertebrae also requires attachment of bone graft across vertebrae parts that are going to be fused, providing firm support and alignment across the initially loose and mobile parts. Gradually, natural bone tissues will grow, encapsulate the graft and fuse those bones steadily.

Although the outcome of this procedure tends to immobilize patients from performing certain movements, spinal fusion has reduced, or completely eliminated, unceasingly on and off sciatic symptoms patients had to suffer prior to the surgery.

Standard fusion method, as explained earlier, involves fixing of bone graft across problematic mobile parts of the vertebrae. The bone graft is intended to provide steady frame or platform for the growth of natural bone tissues that fuse the vertebral segments into one. To firmly attach the bone graft onto the vertebrae, internal screws and rods are fixed onto the spinal pedicles—this improves the chance of success of the procedure. Studies have shown that within 3 months or more, patients on back braces have shown positive implantation of bone graft contributing to effective bone growth and fusion. Incorporation of internal rods and screws has also eliminated the need of external hardware that would add on to the inconvenience of using back braces. With stronger support internally, the chance of having successful bone fusion increases and patients can return to their normal activities a lot quicker.

Interbody grafting is an advancement of the original fusion method. In this type of fusion, not only the bone graft can be attached across the vertebrae segments, but it can also be installed around the back of the spine and even inserted in between the disc spaces. The concept is basically similar to the building of cage, whereby cage ribs is installed almost surrounding the targeted parts. Such implantation of bone graft provides larger surface area for bone tissues to grow and therefore gives better support, implying higher success rate of bone fusion.

There are different methods of interbody fusion. These depend on the direction and technique used to access the intervertebral disc space.

XLIF, which stands for eXtreme Lateral Interbody Fusion, is a method of interbody grafting by which bone graft is inserted into the disc space via a lateral incision on the side of patient’s body. With this mechanism, the surgeon may obtain a clear view on the spine because most abdominal contents are not in the way. However, it is unfortunate that such insertion may affect some of the critically sensitive nerves located at the front of the spine. This will potentially lead to partial weakening of the lower limbs, which is certainly undesirable by any patients. Up to this moment, the success of this procedure has not been proven.

AxiaLIF, or Axial Lumbar Interbody Fusion, is a method of interbody grafting considered least invasive due to its likelihood of not disturbing any nerves. In this method, the surgeon makes a little incision next to patient’s tailbone and uses a set of surgical equipment (tubes and drills) to extract damaged disc material out of the body. Subsequently, he or she will then insert a replacement bone graft into the hollow disc space and fix rods and screws to secure the implant. Similar to XLIF, no thorough researches have clearly shown the effectiveness of this procedure.

Soft fusion is another technique of interbody grafting and it is still under investigation. Theoretically, it is accomplished by using “flexible rods” to secure the bone graft or implant in place instead of the typically rigid rods and screws. While in the so-called hard fusion method the rods and screws are supposed to maintain immobility of the fused segments, soft fusion is intended to allow a certain degree of flexibility causing the spine to be able to perform some motions. The concept behind the use of flexible rods is to provide the required stability to the spine without restricting its mobility. Nevertheless, there has not been any evidential consensus among researchers as to how much or little force is required to achieve this outcome.

Surgical risks of performing spinal fusion

With the older techniques of spinal fusion, surgical procedure could take up to 4 to 6 hours. The relatively long surgery increased the potential risks of complications due to anesthesia, infection and even blood loss. As technology progresses, newer and better methods of performing spinal fusion have been discovered and implemented, which simplify the procedure and reduce surgery time by half. Any risks of surgical complications and blood loss are minimized.

If you happen to require spinal fusion surgery, you are strongly advised to be well-equipped with all possible options and information you would need to finalize your choice. Consult several experts and find out about the different procedures, what each procedure involves, how long it would take, if it would require blood transfusion, and so on. Listen to those who have undergone similar procedures and learn about their post-surgical experiences, their ups and downs after going through the surgery. Don’t forget to ask recommendations on highly trusted surgeons with excellent track records of successful surgeries and figure out if they are really that capable. Be a well-prepared patient by knowing all your options and consequences.

Post-surgery: The First Few Months after Surgery

In contrast with the conventional belief that bed rest is essential shortly after surgery, you should not make excuses to stay in deep slumber simply to avoid being active. In fact, surgeons and physicians have made a strong recommendation that short and gentle exercises performed frequently on daily basis will help speed up bone fusion and therefore overall recovery. How is that so?

Well, there are several reasons why it is crucial that patients perform mild exercises within first few weeks after spinal fusion surgery. As you may know, after surgery your body may stiffen not only because of the side effect of anesthesia but also due to laying down for quite some time. Secondly, it is always necessary to strengthen the back muscles that support the recovering spine yet at the same time prevent excessive pressure applied onto the spine from, probably, extra weight gain. In addition, simple movements may also prevent formation of scar tissues or adhesive substance that may distort the healing process of the joined segments. Last but not least, maintaining a healthy blood circulation is always good to promote faster bone formation because fresh oxygen and nutrients in blood will constantly rejuvenate the body giving it more energy to promote new cell growth.

With all this in mind, you shouldn’t hesitate to consult your surgeon and physician on the kinds of exercises you may do for the first and subsequent few weeks. The type of exercises recommended may depend on the applied technique, location of fusion, degree of severity or number of fused segments and individual rate of recovery.

Generally, slow walking and light stretching may be performed within the first few weeks of recovery. Repeated gentle movements of both your arms and legs are also good to improve overall stability. During this period, you should avoid sudden and heavy movements such twisting your back. You may, however, gradually increase your walking distance as the pain eases off.

In about 6 weeks, your body should be able to accommodate more active exercises and within 9 weeks, you may have been capable of performing brisk walking, swimming and other non-turbulence forms of exercises. Nevertheless, you still need to avoid doing any forms of activities that physically cause significant or sudden stretching or shaking to your spine—jogging, matches such as tennis and badminton and contact sports such as boxing and martial arts are some examples.

For more thorough information on post-fusion exercises, you may visit the following page:

Adjacent Segmental Degeneration: A Potential Long-term Effect of Spinal Fusion

Yes, you may have been capable to perform numerous activities many months or years after performing spinal fusion procedure. But, you still need to be aware that doing those activities are not without a risk. By agreeing to perform the surgical procedure, you have understood that the mobility of your affected backbone or vertebrae is significantly reduced—up to the point it may become completely immobile. Insisting on performing certain physical activities, despite seemingly not harmful may only cause gradual degeneration of tissues and joints around the fusion site. This phenomenon is called adjacent segmental degeneration, or simply abbreviated to ASD.

ASD is basically resulted from incapability of fused segments to take in or absorb tension from physical movements applied on them. Hence, they transfer this force onto their adjacent components causing them to wear off over time.

The risk of ASD increases the higher the level of spinal fusion acquired. Therefore, it is always important to constantly limit the types of activities you would take on after such surgery. Those that involve jerking of spine such as running, hiking and outdoor cycling, or those that involve combination of strength and twisting of spine such as golf and racket games, are always best to avoid.

If you have had a spinal fusion procedure before, the most ideal form of sports for you is swimming or water aerobics. Water takes off the tension off your spine yet, at the same time, it provides necessary support for your body to stay healthy. Another alternative would be to go for exercise machines that cause minimum or no jarring to the body. Some examples include static bicycle and cross-trainer or elliptical trainer; both of which prevent sudden stretch and compression to the spine.

Nevertheless, some of you may not afford losing your athletically active life. What if such is the case? Is there an alternative?

Disc Replacement Surgery: An Alternative to Spinal Fusion

For those of you who do mind losing your mobility and becoming less active, you may want to consider DSR, or disc replacement surgery, instead of going for immobilizing spinal fusion. In DSR, rather than fusing original bones by promoting new growth of bone cells, the damaged spinal bones—vertebrae and intervertebral discs—are replaced with artificial implants made of metal with plastic cushioning of disc nucleus if necessary.

With DSR, no discs are joined into one segment; instead every disc stands and functions on its own, absorbing tension in its own accord. Thus, there is no risk of ASD, even after many years of having those implants. In other words, there is a higher chance that you would still be able to do activities that cannot be performed by spinal fusion patients.

Unlike spinal fusion, DSR offers you the benefit of total mobility after surgery. Hence, despite a decade long of popularity of spinal fusion procedure, there has been increasing demand on DSR in the US over the years.

Nevertheless, like any other surgical procedure, DSR also presents its own potential risks worthy to note of. Therefore, it is again always wise to consult the experts on a variety of options before deciding to proceed with one. Besides, it is eventually the quality of your own life you are determining—how you would want to live your life.

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