Spinal fusion - wikipedia Spinal fusion Spinal fusion Fusion of L5 and S1 ICD - 9 - CM 81.0 MeSH D013123 MedlinePlus 002968 ( edit on Wikidata ) Spinal fusion, also called spondylodesis or spondylosyndesis, is a neurosurgical or orthopedic surgical technique that joins two or more vertebrae. This procedure can be performed at any level in the spine ( cervical, thoracic, or lumbar ) and prevents any movement between the fused vertebrae. There are many types of spinal fusion and each technique involves using bone grafting - either from the patient ( autograft ), donor ( allograft ), or artificial bone substitutes - to help the bones heal together. Additional hardware ( screws, plates, or cages ) is often used to hold the bones in place while the graft fuses the two vertebrae together. Spinal fusion is most commonly performed to relieve the pain and pressure on the spinal cord that results when a disc ( cartilage between two vertebrae ) wears out ( degenerative disc disease ). Other common pathological conditions that are treated by spinal fusion include spinal stenosis, spondylolisthesis, spondylosis, spinal fractures, scoliosis, and kyphosis. Like any surgery, complications may include infection, blood loss, and nerve damage. Fusion also changes the normal motion of the spine and results in more stress on the vertebrae above and below the fused segments. As a result, long - term complications include degeneration at these adjacent spine segments. Contents 1 Medical uses 2 Contraindications 3 Epidemiology 4 Costs 5 Technique 5.1 Cervical spine 5.2 Thoracic spine 5.3 Lumbar spine 6 Risks 6.1 During surgery 6.2 Within a few days 6.3 Weeks to years following surgery 7 Recovery 8 Usage 9 References 10 Further reading 11 External links Medical uses Spinal fusion can be used to treat a variety of conditions affecting any level of the spine - lumbar, cervical and thoracic. In general, spinal fusion is performed to decompress and stabilize the spine. The most common cause of pressure on the spinal cord / nerves is degenerative disc disease. Other common causes include disc herniation, spinal stenosis, trauma, and spinal tumors. Spinal stenosis results from bony growths ( osteophytes ) or thickened ligaments that cause narrowing of the spinal canal over time. This causes leg pain with increased activity, a condition called neurogenic claudication. Pressure on the nerves as they exit the spinal cord ( radiculopathy ) causes pain in the area where the nerves originated ( leg for lumbar pathology, arm for cervical pathology ). In severe cases, this pressure can cause neurologic deficits, like numbness, tingling, bowel / bladder dysfunction, and paralysis. Lumbar and cervical spinal fusions are more commonly performed than thoracic fusions. Degeneration happens more frequently at these levels due to increased motion and stress. The thoracic spine is more immobile, so most fusions are performed due to trauma or deformities like scoliosis and kyphosis. Herniated disc pressing on spinal nerves. Conditions where spinal fusion may be considered include the following : Degenerative disc disease Spinal disc herniation Discogenic pain Spinal tumor Vertebral fracture Scoliosis Kyphosis ( e.g., Scheuermann 's disease ) Spondylolisthesis Spondylosis Posterior rami syndrome Other degenerative spinal conditions Any condition that causes instability of the spine Contraindications Bone morphogenetic protein ( rhBMP ) should not be routinely used in any type of anterior cervical spine fusion, such as with anterior cervical discectomy and fusion. There are reports of this therapy causing soft tissue swelling, which in turn can cause life - threatening complications due to difficulty swallowing and pressure on the respiratory tract. Epidemiology According to a report by the Agency for Healthcare Research and Quality ( AHRQ ), approximately 488,000 spinal fusions were performed during U.S. hospital stays in 2011 ( a rate of 15.7 stays per 10,000 population ), which accounted for 3.1 % of all operating room procedures. This was a 70 percent growth in procedures from 2001. Lumbar fusions are the most common type of fusion performed ~ 210,000 per year. 24,000 thoracic fusions and 157,000 cervical fusions are performed each year. A 2008 analysis of spinal fusions in the United States reported the following characteristics : Average age for someone undergoing a spinal fusion was 54.2 years - 53.3 years for primary cervical fusions, 42.7 years for primary thoracic fusions, and 56.3 years for primary lumbar fusions 45.5 % of all spinal fusions were on men 83.8 % were white, 7.5 % black, 5.1 % Hispanic, 1.6 % Asian or Pacific Islander, 0.4 % Native American Average length of hospital stay was 3.7 days - 2.7 days for primary cervical fusion, 8.5 days for primary thoracic fusion, and 3.9 days for primary lumbar fusion In - hospital mortality was 0.25 % Costs Costs associated with spinal fusion vary depending on the medical institution, insurance, type of surgery and the overall health of the patient. Total costs typically include labs, medications, room & board, medical supplies, recovery room, operating room services, physical therapy, imaging, and hospital charges. The average total hospital costs for spinal fusions increased from $24,676 in 1998 to $81,960 in 2008. The average total costs of common fusion procedures are listed below : $34,943 - Anterior cervical discectomy and fusion ( ACDF ) for someone with severe obesity and diabetes ( 2005 - 2008 ) $25,633 - ACDF for someone without obesity and diabetes ( 2005 - 2008 ) $65,782 - Lumbar decompression and fusion ( LDF ) for someone with diabetes and depression ( 2005 - 2008 ) $52,249 - LDF for someone without diabetes or depression ( 2005 - 2008 ) $80,095 - Upper thoracic level primary spinal fusion ( 2003 - 2013 ) $55,547 - Revision of previous fusion surgery due to adjacent segment disease ( 2003 - 2013 ) Technique There are many types of spinal fusion techniques. Each technique varies depending on the level of the spine and the location of the compressed spinal cord / nerves. After the spine is decompressed, bone graft or artificial bone substitute is packed between the vertebrae to help them heal together. In general, fusions are done either on the anterior ( stomach ), posterior ( back ), or both sides of the spine. Today, most fusions are supplemented with hardware ( screws, plates, rods ) because they have been shown to have higher union rates than non-instrumented fusions. Minimally invasive techniques are also becoming more popular. These techniques use advanced image guidance systems to insert rods / screws into the spine through smaller incisions, allowing for less muscle damage, blood loss, infections, pain, and length of stay in the hospital. The following list gives examples of common types of fusion techniques performed at each level of the spine : Anterior approach to cervical spine. Cervical spine Anterior cervical discectomy and fusion ( ACDF ) Anterior cervical corpectomy and fusion Posterior cervical decompression and fusion Thoracic spine Anterior decompression and fusion Posterior instrumentation and fusion -- many different types of hardware can be used to help fuse the thoracic spine including sublaminar wiring, pedicle and transverse process hooks, pedicle screw - rod systems, vertebral body plate systems. Lumbar spine Posterolateral Fusion - bone graft is placed between the transverse processes in the back of the spine. These vertebrae are then fixed in place with screws and / or wire through the pedicles of each vertebra attaching to a metal rod on each side of the vertebrae. Interbody Fusion - the entire intervertebral disc between vertebrae is removed and bone graft is placed in the space between the vertebra. A plastic or titanium device may be placed between the vertebra to maintain spine alignment and disc height. The types of interbody fusion are : Anterior lumbar interbody fusion ( ALIF ) -- the disc is accessed from an anterior abdominal incision Posterior lumbar interbody fusion ( PLIF ) -- the disc is accessed from a posterior incision Transforaminal lumbar interbody fusion ( TLIF ) -- the disc is accessed from a posterior incision on one side of the spine Transpsoas interbody fusion ( DLIF or XLIF ) -- the disc is accessed from an incision through the psoas muscle on one side of the spine Oblique lateral lumbar interbody fusion ( OLLIF ) -- the disc is accessed from an incision through the psoas muscle obliquely Stabilization rods used after spinal fusion surgery. Risks Spinal fusion is a high risk surgery and complications can be serious, including death. In general, there is a higher risk of complications in older people with elevated body mass index ( BMI ), other medical problems, poor nutrition and nerve symptoms ( numbness, weakness, bowel / bladder issues ) before surgery. Complications also depend on the type / extent of spinal fusion surgery performed. There are three main time periods where complications typically occur : During surgery Patient positioning on operating table Blood loss Damage to nerves and surrounding structures during procedure Insertion of spinal hardware Harvesting of bone graft ( if autograft is used ) Within a few days Wound infections - risk factors include old age, obesity, diabetes, smoking, prior surgery Deep vein thrombosis ( DVT ) Pulmonary embolism ( PE ) Urinary retention Malnutrition Neurologic deficit Weeks to years following surgery Infection Deformity - loss of height, alignment, and failure of fusion Pseudarthrosis - nonunion between fused bone segments. Risk factors include tobacco use, nonsteroidal anti-inflammatory drug use, osteoporosis, revision procedures, decreased immune system. Adjacent segment disease - degeneration of vertebrae above / below the fused segments due to increased stress and motion. Epidural fibrosis - scarring of the tissue that surrounds the spinal cord Arachnoiditis - inflammation of the thin membrane surrounding the spinal cord, usually caused by infection or contrast dye. Recovery Recovery following spinal fusion is extremely variable, depending on individual surgeon 's preference and the type of procedure performed. The average length of hospital stay for spinal fusions is 3.7 days. Some patients can go home the same day if they undergo a simple cervical spinal fusion at an outpatient surgery center. Minimally invasive surgeries are also significantly reducing the amount of time spent in the hospital. Recovery typically involves both restriction of certain activities and rehabilitation training. Restrictions following surgery largely depend on surgeon preference. A typical timeline for common restrictions after a lumbar fusion surgery are listed below : Walking - most people are out of bed and walking the day after surgery Sitting - can begin at 1 -- 6 weeks following surgery Lifting - it is generally recommended to avoid lifting until 12 weeks Driving - usually can begin at 3 -- 6 weeks Return to sedentary work - usually between 3 -- 6 weeks Return to manual work - between 7 -- 12 weeks Rehabilitation after spinal fusion is not mandatory. There is some evidence that it improves functional status and low back pain so some surgeons may recommend it. Usage According to a report by the Agency for Healthcare Research and Quality ( AHRQ ), approximately 488,000 spinal fusions were performed during U.S. hospital stays in 2011 ( a rate of 15.7 stays per 10,000 population ), which accounted for 3.1 % of all operating room procedures. References ^ Jump up to : Chou, Roger ( March 11, 2016 ). `` Subacute and Chronic Low Back Pain : Surgical Treatment ''. UpToDate. ^ Jump up to : Rajaee, Sean ( 2012 ). `` Spinal Fusion in the United States ''. Spine. 37 : 67 -- 76. ^ Jump up to : Agulnick, Marc ( 2017 ). Orthopaedic Surgery Essentials : Spine. Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103 USA : Lippincott Williams & Wilkins. p. 343. ISBN 978 - 1 - 49631 - 854 - 1. ^ Jump up to : Rajaee, Sean S. ; Bae, Hyun W. ; Kanim, Linda E.A. ; Delamarter, Rick B. `` Spinal Fusion in the United States ''. Spine. 37 ( 1 ) : 67 -- 76. doi : 10.1097 / brs. 0b013e31820cccfb. ^ Jump up to : North American Spine Society ( February 2013 ), `` Five Things Physicians and Patients Should Question '', Choosing Wisely : an initiative of the ABIM Foundation, North American Spine Society, retrieved 25 March 2013, which cites Schultz, Daniel G. ( July 1, 2008 ). `` Public Health Notifications ( Medical Devices ) - FDA Public Health Notification : Life - threatening Complications Associated with Recombinant Human Bone Morphogenetic Protein in Cervical Spine Fusion ''. fda.gov. Retrieved 25 March 2014. Woo, EJ ( Oct 2012 ). `` Recombinant human bone morphogenetic protein - 2 : adverse events reported to the Manufacturer and User Facility Device Experience database ''. The Spine Journal. 12 ( 10 ) : 894 -- 9. doi : 10.1016 / j. spinee. 2012.09. 052. PMID 23098616. ^ Jump up to : Weiss AJ, Elixhauser A, Andrews RM ( February 2014 ). `` Characteristics of Operating Room Procedures in U.S. Hospitals, 2011 ''. HCUP Statistical Brief # 170. Rockville, MD : Agency for Healthcare Research and Quality. Jump up ^ Weiss AJ, Elixhauser A ( March 2014 ). `` Trends in Operating Room Procedures in U.S. Hospitals, 2001 -- 2011 ''. HCUP Statistical Brief # 171. Rockville, MD : Agency for Healthcare Research and Quality. ^ Jump up to : Walid, M. Sami ; Robinson, Joe Sam ( 2011 - 01 - 14 ). `` Economic impact of comorbidities in spine surgery ''. Journal of Neurosurgery : Spine. 14 ( 3 ) : 318 -- 321. doi : 10.3171 / 2010.11. SPINE10139. ISSN 1547 - 5654. ^ Jump up to : Theologis, Alexander A. ; Miller, Liane ; Callahan, Matt ; Lau, Darryl ; Zygourakis, Corinna ; Scheer, Justin K. ; Burch, Shane ; Pekmezci, Murat ; Chou, Dean ( 2016 - 08 - 15 ). `` Economic Impact of Revision Surgery for Proximal Junctional Failure After Adult Spinal Deformity Surgery ''. Spine. 41 ( 16 ) : E964 -- E972. doi : 10.1097 / brs. 0000000000001523. ISSN 1528 - 1159. ^ Jump up to : Phan, Kevin ; Rao, Prashanth J. ; Mobbs, Ralph J. ( 2015 - 08 - 01 ). `` Percutaneous versus open pedicle screw fixation for treatment of thoracolumbar fractures : Systematic review and meta - analysis of comparative studies ''. Clinical Neurology and Neurosurgery. 135 : 85 -- 92. doi : 10.1016 / j. clineuro. 2015.05. 016. ISSN 1872 - 6968. PMID 26051881. Jump up ^ McGregor, Alison H. ; Dicken, Ben ; Jamrozik, Konrad ( 2006 - 05 - 31 ). `` National audit of post-operative management in spinal surgery ''. BMC Musculoskeletal Disorders. 7 : 47. doi : 10.1186 / 1471 - 2474 - 7 - 47. ISSN 1471 - 2474. PMC 1481518. PMID 16737522. ^ Jump up to : Shields, Lisa B.E. ; Clark, Lisa ; Glassman, Steven D. ; Shields, Christopher B. ( 2017 - 01 - 19 ). `` Decreasing hospital length of stay following lumbar fusion utilizing multidisciplinary committee meetings involving surgeons and other caretakers ''. Surgical Neurology International. 8. doi : 10.4103 / 2152 - 7806.198732. ISSN 2229 - 5097. PMC 5288986. PMID 28217384. ^ Jump up to : McGregor, Alison H. ; Probyn, Katrin ; Cro, Suzie ; Doré, Caroline J. ; Burton, A. Kim ; Balagué, Federico ; Pincus, Tamar ; Fairbank, Jeremy ( 2013 - 12 - 09 ). `` Rehabilitation following surgery for lumbar spinal stenosis ''. The Cochrane Database of Systematic Reviews ( 12 ) : CD009644. doi : 10.1002 / 14651858. CD009644. pub2. ISSN 1469 - 493X. PMID 24323844. Further reading Cervical Spinal Fusion. WebMD. A Patient 's Guide to Anterior Cervical Fusion. University of Maryland Medical Center. Boatright, K.C. and S.D. Boden. Chapter 12 : Biology of Spine Fusion. In : Lieberman, J., et al., Eds. Bone Regeneration and Repair. Totowa, New Jersey : Humana Press. 2005. pp. 225 -- 239. ISBN 978 - 0 - 89603 - 847 - 9. Holmes, C.F., et al. Chapter 9 : Cervical Spine Injuries. In : Schenck, R.F., AAOS. Athletic Training in Sports Medicine. Jones & Bartlett Publishers. 2005. pp. 197 -- 218. ISBN 0 - 89203 - 172 - 7 Camillo, F.X. Chapter 36 : Arthrodesis of the Spine. In : Canale, S.T. and J.H. Beaty. Campbell 's Operative Orthopaedics 2. ( 11th Ed. ). Philadelphia : Mosby. 2007. pp. 1851 -- 1874. ISBN 978 - 0 - 323 - 03329 - 9. Williams, K.D. and A.L. Park. Chapter 39 : Lower Back Pain and Disorders of Intervertebral Discs. In : Canale, S.T. and J.H. Beaty. Campbell 's Operative Orthopaedics 2. ( 11th Ed. ). Philadelphia : Mosby. 2007. pp. 2159 -- 2224. ISBN 978 - 0 - 323 - 03329 - 9. Weyreuther, M., et al., Eds. Chapter 7 : The Postoperative Spine. MRI Atlas : Orthopedics and Neurosurgery -- The Spine. trans. B. Herwig. Berlin : Springer - Verlag. 2006. pp. 273 -- 288. ISBN 978 - 3 - 540 - 33533 - 7. Tehranzadehlow, J., et al. ( 2005 ). Advances in spinal fusion. Seminars in Ultrasound, CT, and MRI 26 ( 2 ) : 103 -- 113. Resnick, D.K., et al. Surgical Management of Low Back Pain ( 2nd Ed. ). Rolling Meadows, Illinois : American Association of Neurosurgeons. 2008. ISBN 978 - 1 - 60406 - 035 - 5. Oblique Lateral Lumbar Interbody Fusion ( OLLIF ) : Technical Notes and Early Results of a Single Surgeon Comparative Study. NIH. External links Wheeless, C.R., et al., Eds. Fusion of the Spine. Wheeless ' Textbook of Orthopaedics. Division of Orthopedic Surgery. Duke University Medical Center. Spinal Fusion. American Academy of Orthopaedic Surgeons. June 2010. Accessed 1 June 2013. Spinasanta, S. What is Spinal Instrumentation and Spinal Fusion ? SpineUniverse. September 2012. Accessed 1 June 2013. Spinal fusion. Encyclopedia of Surgery. Accessed 1 June 2013. Orthopedic surgery, operations / surgeries and other procedures on bones and joints ( ICD - 9 - CM V3 76 -- 81, ICD - 10 - PCS 0P -- S ) Bones Facial Jaw reduction Dentofacial osteotomy Genioplasty / Mentoplasty Chin augmentation Orthognathic surgery Spine Coccygectomy Laminotomy Laminectomy Laminoplasty Corpectomy Facetectomy Foraminotomy Vertebral fixation Percutaneous vertebroplasty Upper extremity Acromioplasty Lower extremity Femoral head ostectomy Astragalectomy Distraction osteogenesis Ilizarov apparatus General Ostectomy Bone grafting Osteotomy Epiphysiodesis Reduction Internal fixation External fixation Tension band wiring Cartilage Articular cartilage repair Microfracture surgery Knee cartilage replacement therapy Autologous chondrocyte implantation Joints Spine Arthrodesis Spinal fusion Intervertebral discs Discectomy Annuloplasty Arthroplasty Upper extremity Shoulder surgery Shoulder replacement Bankart repair Weaver -- Dunn procedure Ulnar collateral ligament reconstruction Hand surgery Brunelli procedure Lower extremity Hip resurfacing Hip replacement Rotationplasty Anterior cruciate ligament reconstruction Knee replacement / Unicompartmental knee arthroplasty Ankle replacement Broström procedure Triple arthrodesis General Arthrotomy Arthroplasty Synovectomy Arthroscopy Replacement joint imaging : Arthrogram Arthrocentesis Retrieved from `` https://en.wikipedia.org/w/index.php?title=Spinal_fusion&oldid=821834754 '' Categories : Neurosurgical procedures Orthopedic surgical procedures Talk Contents About Wikipedia Deutsch فارسی Nederlands Polski Русский ไทย Edit links This page was last edited on 22 January 2018, at 22 : 19. 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Question: what does it mean to fuse the spine
Answer: a neurosurgical or orthopedic surgical technique that joins two or more vertebrae; joins two or more vertebrae; joins two or more vertebrae; a neurosurgical or orthopedic surgical technique that joins two or more vertebrae