Spinal Fusion Surgery

Spinal surgery is a complex and critical surgery and requires highly trained and skilled surgeons, excellent infrastructure, good post- op care for a successful outcome. Our surgeons use neuro-monitoring technique during the surgery for complete safety of the patient and a great outcome. Besides, the cost of spinal fusion surgery in India is much affordable, thus attracting people from across the world for their spinal fusion surgery in India.

Overview
Spinal fusion surgery is a procedure that fuses two or more spinal vertebrae permanently to eradicate the movement between them, thus bringing stability to the vertebral segments and eliminating the pain associated with them.
The pain may be a result of injury or natural ageing process. The unstable spine causes abnormal movement between the vertebrae causing pain in back, legs or arms. Spinal fusion aligns and stabilizes the spine, maintains the normal disc space between the vertebrae, alleviates pain and prevents damage to the spinal cord and nerves.
Spinal fusion may relieve symptoms of many back conditions, including:

• Fracture of vertebrae though can heal without spinal fusion surgery, but in few cases surgery is done if the fracture is making the spinal vertebrae unstable.
• Fracture of vertebrae though can heal without spinal fusion surgery, but in few cases surgery is done if the fracture is making the spinal vertebrae unstable.
• Deformities in the spine like scoliosis or kyphosis.
• Degenerative disc disease and herniated disc
• Spondylolisthesis where vertebra slips onto the below one. It causes severe pain in the back and legs with leg numbness.
• Other causes like tumour, infection spinal stenosis and so on

Treatment options:
Different types of spinal fusion surgeries are commonly available, like:

• Posterior lumbar inter-body fusion (PLIF) creates space between two vertebrae and induces bone in that space. This procedure is done from the back.
• Posterolateral gutter fusion
• Anterior lumbar inter-body fusion (ALIF) is the same as PILF. The only difference is that the spine is approached from the front.
• Trans-foraminal lumbar inter-body fusion (TLIF)
• Extreme Lateral Inter-body Fusion (XLIF) procedure is done from the side
• Multilevel Spinal Fusion : Lumbar spinal fusion surgery is the most effective procedure for problems involving one segment of spinal vertebra as the movement improves with this.For some cases of pain, two levels can be fused though it places lot of pressure on the remaining joints. Three or more levels of fusion are done in cases of scoliosis and lumbar deformity. Multilevel spinal fusions are used to treat lower back pain and lumbar degenerative disc diseases.
• ACDF : Anterior Cervical Discectomy and Fusion is used to relieve cervical disc herniation symptoms like spinal cord and nerve root pressure and associated numbness, pain, and tingling. The disc is removed with the fusion surgery in the ACDF procedure. It can also bedone for cervical degenerative disc disease and for more levels of cervical spine.

Candidates
Spinal fusion surgery is done when other non-surgical treatments like medication, physiotherapy and injections have not relieved the patient of pain in back, legs and arms because of the excessive abnormal motion at a vertebral segment.
Spinal fusion surgery is also done in case of degenerative disc disease, Spondylolisthesis (isthmic, degenerative or post-laminectomy spondylolisthesis).
Spinal fusion surgery is also advised to treat a weak or unstable spine because of infection or spinal tumour, fractures, scoliosis or any other deformity.
A good candidate for spinal fusion surgery is one who is otherwise in good physical condition, can tolerate the procedure well.

Procedure
Spinal fusion surgery is done by placing bone graft between the two vertebral bodies causing them to grow together into one long bone. The bone graft can either be obtained from the patient’s own body (known as auto-graft) or from a cadaver (called as allograft) or a man-made graft of plastic or ceramic. Selection of right kind of procedure depends on the nature and location of the disease.

Lumbar Spine Fusion Surgery
Lumbar fusion surgery is done to make the patient relieve from low back pain radiating to hip and legs. There are many techniques to do a lumbar fusion surgery, but all the techniques involve using a bone graft between the two vertebrae to create fusion and thus stopping movement at that segment.
Various types of spinal fusion surgeries include:

• Posterolateral gutter fusion involves accessing the spine through the back.
• Posterior lumbar inter-body fusion (PLIF/TLIF) involves accessing the spine through back while the patient lies on his stomach. The procedure entails removing the disc between two vertebrae and inserting the bone graft in the space.
• Anterior lumbar inter-body fusion (ALIF) – same as TLIF or PLIF except that the spine is accessed from the front. The technique remains the same.
• Anterior/posterior spinal fusion spine is accessed from back and front both Minimally invasive techniques involve fusions to be done with smaller incisions.

Bone Grafting
Any spinal fusion procedure requires bone grafts to help in fusion. Bone grafts stimulate bone healing and help vertebrae to fuse into a solid bone or even act as structural support in case of bigger bone grafts. Grafts from one’s own body is called auto graft. Another kind of graft is called cadaver bone graft is typically acquired through a bone bank.
Immobilization with braces, plates, rods and screws are used to stabilize the bone and for internal fixation which speeds up the healing process.

Multiple level Spinal Fusion Surgery
Lumbar spinal fusion surgery is most effective in conditions involving only one vertebral segment because the patient does not feel any limitation in the motion after fusion at one level. In case necessary, fusing two levels is a reasonable option to treat pain. However, spinal fusion for more than two levels can cause too much stress across the remaining spinal joints causing pain at other levels. Only in rare cases three or more level fusion is advised such as scoliosis and lumbar deformity.

Cervical Spine fusion surgery
This involves fusing cervical spinal bones in case of injuries to stabilize the neck and to prevent vertebral fracture that damage the spinal cord and cause paralysis. Cervical spine fusion surgery is also done to treat spinal stenosis, herniated disc, infection, tumour or other spinal deformities.

Expected Results
Spinal fusion surgery is effective in relieving the patient of disabling pain. The long term success of spinal fusion depends upon a number of factors such as surgeon’s expertise, proper selection of patient, patient with healthy lifestyle( non-smoker and non-obese) who is motivated to pursue rehabilitation and restoration of the spinal functions.

Recovery
You would stay at the hospital for a week following spinal fusion surgery in India to make sure you are on the right healing path. You may be advised to wear a back brace while you recover. You can slowly return to your daily activities in about 2-3 weeks but rigorous activities will have to wait for few months.

Time and Cost
If you are coming from abroad for spinal fusion surgery in India, you would need a stay of about 3 weeks in India for surgery, initial recovery and rehabilitation.