Spinal fusion is a surgical procedure that involves permanently joining two or more vertebrae in the spine to treat conditions such as spinal stenosis, herniated discs, and spondylolisthesis. While spinal fusion can be an effective treatment option, it is not always necessary, and there are alternatives to consider.
Regenerative medicine, including injections of a patient’s own repair cells or blood platelets, could someday replace the scalpel as a major alternative for treating degenerative disc disease, a significant cause of chronic lower back pain, says orthopedic spine surgeon Praveen Kadimcherla, MD.
In addition, recent advancements in robotic technology and minimally invasive techniques are also transforming conventional spinal surgery by speeding patient recovery and reducing the risk of post-operative pain and complications, explains Dr. Kadimcherla.
His comments follow the latest scientific report, published in April 2019 in Neurosurgical Focus. The study indicated that transforaminal lumbar fusion, a procedure to stabilize the spine and mitigate severe back pain in patients with damaged discs, is being performed in some instances without general anesthesia and with less cutting of tissue and muscles. The surgeon integrates minimally-invasive endoscopic methods during the operation while the patient remains conscious, Dr. Kadimcherla says.
“Some 500,000 traditional spinal fusion surgeries, including cervical spine surgery, are still performed in the United States but a variety of novel approaches are emerging in response to the growing incidence of chronic back pain problems,” says Dr. Kadimcherla, who himself is investigating use of an ultrasonic bone scalpel to improve results of common spine-surgery procedures.
Among the most exciting non-surgical advancements is the infusion of a patient’s own blood platelets or adult (mesenchymal) repair cells to regenerate diseased discs and the damaged tissue around them, Dr. Kadimcherla says. “Most traditional treatment methods for degenerative disc disease address only the symptoms. With cell-based strategies, we have the potential for attacking the very source of the pain.”
He concurs with authors of a September 2018 article in JOR Spine who write that repair cell and plasma-rich platelet infusion, intervertebral disc cell isolation and reconditioning, tissue engineering and biomaterial-based strategies represent a new frontier, holding promise as “effective solutions” for degenerative disc disease and lower back pain in many patients.
The leading cause of disability globally, lower back pain affects between six and eight of every 10 adult Americans and is reportedly this country’s third most costly health condition. A leading culprit for the pain, degenerative disc disease, is a common development of advancing age, although it can occur earlier due to injury or genetics.
Called the spine’s “shock absorbers,” discs in the spine are gel-filled capsules located between the spine’s bony vertebrae. They prevent vertebrae from rubbing together and help maintain spine flexibility. During the normal aging process, discs can dry out and become more brittle. This process forces a disc’s outer membrane to crack and its inner core material to ooze out, oftentimes pressing against surrounding nerves and causing pain.
Spinal fusion surgery is frequently recommended for patients who have unrelenting back pain that has not responded to more conservative, non-surgical approaches, such as light exercise, physical therapy and medications. Surgery involves the placement of small pieces of bone either in the disc space or along the back of the diseased section of the spine. The intent is to have the bone grow (fuse) together, limiting motion in that portion of the spine since it is a motion that causes diseased discs to rub together and irritate nerves, Dr. Kadimcherla explains. Among the disadvantages of this procedure is quite a long spinal fusion recovery period.
Surgical alternatives to spinal fusion include
- Replacement of a diseased disc with an artificial motion device. The surgery has the advantage of preserving spinal motion but is more complicated, and the device can wear out or fail.
- Intradiscal electrothermal or radiofrequency coagulation, an outpatient procedure that involves applying heat or energy on the outer core of the disc space through an inserted catheter in order to close disc cracks, cauterize nerve endings and reduce pain.
- Decompression back surgery, designed to remove a small amount of bone or disc material from around a nerve root.
“Each procedure has benefits and drawbacks,” says Dr. Kadimcherla. “That’s why it’s so important for patients to select an experienced orthopedic specialist who can help them make the best choices.”
For patients with chronic back pain, he offers these tips before opting for more extensive procedures
- Be serious about pain management. Consider a variety of measures, including over-the-counter anti-inflammatory medications, epidural steroid injections and physical therapy – even acupuncture, to find a combination that works.
- Stay active; exercise. Low-impact aerobics like swimming can be helpful.
- Change your behaviors. Stop smoking, lose weight, and maintain good posture while sitting and standing.
In conclusion, spinal fusion is not always necessary, and there are several non-surgical and minimally invasive treatments available to manage spinal conditions. These treatments can be effective in reducing pain, improving function, and preventing further damage to the spine. It's essential to consult with a healthcare provider to determine which treatment option is best suited for your individual needs and condition.
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Minimally Invasive Spine Procedures
Artificial Disc Replacement vs. Fusion