Spine Fusion Surgery
Spine Fusion
Spinal fusion and fixation is needed whenever there is instability in the spine as a result of degenerative process, trauma, tumor or infection. Fusion surgery is needed to restore the balance of the spine and to restrict pathological mobility. It involves uniting the adjacent segments of the spine by placing a bone graft between them and fixing them with metallic implants- screws and plates.
Such instability is usually diagnosed by X ray and MRI and occasionally CT scan may be needed. Fixation Surgery is done under General Anaesthesia. Different types of implants are used for different regions of the spine.
For lumbar and thoracic surgeries, usually spine is accessed via an incision on the back at the affected level. Muscles are dissected and spine is approached.
Fusion of the lumbar spine involves placing pedicle screws at multiple levels on either sides, which are connected through rods. For cases of listhesis, the disc space is filled with bone chips and an Interbody fusion cage is placed between the vertebral body end plates, in addition to the pedicle screws.
Similar type of implants are used for the thoracic spine. Sometimes the thoracic and the lumbar spine may be approached from the anterior/lateral aspect via the thorax or the abdomen. It involves decompression and fixing the spine via interbody cage from the anterior aspect.
Fixation in the cervical spine may be done with anterior or the posterior aspect. Some cases require anterior and posterior combined fixation known as 360 degree fixation. Fixation from the anterior aspect involves discectomy at the affected level along with placing bone grafts in the disc space and overlaying a cervical plate which is fixed to the vertebral bodies above and below the level with screws. Now a days, preformed cervical cage-plate with fixed slots for screws are available for cervical fixation. Whenever cervical body is destroyed by trauma, tumor or needs to be removed, the procedure named as corpectomy is being done. It is than being replaced either by bone graft or by an expandable mesh cage to bridge the gap and fix the spine.
Fixation of the cervical spine from the posterior aspect i.e. back of the neck involves placing screws through the lateral mass of the cervical vertebrae, and screws are connected by rods on either side.
Cases of the Cranio Vertebral Junction deserves special mention. It involves dissection of the C1-C2 joints and their distraction with fusion using bone grafts with or without spacer in the joints. This helps in bringing the odontoid process down and decreases compression on the spinal cord. Further CVJ is fixed via putting lateral mass screws in first vertebrae and pars, pedicle screw or translaminar screws in second vertebra. Alternatively occipital plate and screw may be used in place of C1 lateral mass screws. Fracture of the odontoid process of second vertebra is a relatively rare entity. Certain types of odontoid fractures require surgery. A special type of lag screw, odontoid screw is inserted through the fracture segments under C arm guidance. Alternatively C1-C2 fixation may be done for cases unsuitable for odontoid screw surgery.
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