Spinal fusion - is surgery, aimed at creating stillness between adjacent vertebrae (fusion) by setting them between the bone graft.
Indications for spinal fusion
Among the major indication for spinal fusion include:
Fractures of the vertebrae
Tumors of the vertebral
As part of the deletion of the intervertebral disc
Before you perform this operation, the doctor examines the patient. Are all necessary investigations: radiography, CT, MRI, electromyography.
How is the Spondylodesis
Between each vertebra is an intervertebral disc and facet joints, which provide movement in this segment of the spine. When fusion is carried out the removal of this mobility, by removing the intervertebral disc between the vertebrae and the creation of fusion. To create a fusion between the vertebrae are usually injected a small piece of bone the patient, taken from the ilium of the pelvis, or the bone of a corpse. In addition, there are also artificial bone grafts (synthetic).
In general, spinal fusion is effective in patients who require immobilization of only one segment of the spine. The majority of patients do not notice any restriction of mobility in the case of fusion of a spinal segment.
Types of Spondylodesis
Posterior lumbar spinal fusion interkorporalny - this operation is the removal of the intervertebral disc and the introduction instead of the bone plate.
Anterior lumbar fusion interkorporalny - this operation is carried out through the front access.
Bone graft for spine fusion
Bone graft for spinal fusion may be obtained from both the patient and from cadaveric material.
Autologous transplant. Autologous material - is one that is made from the patient's own tissue. Usually used for this purpose ilium of the pelvis. This material contains calcium, and cells - osteoblasts, which are responsible for the regeneration of bone tissue, and hence contribute to the emergence of fusion between the vertebrae.
Allograft. This bone is taken from the corpse, and specially processed. This just gives bone calcium, but does not contain cells that contribute to fusion.
Lack of autologous transplanitatov is pain that occurs after surgery in an area where bone was taken.
Currently, some medical centers instead of bone graft fusion is applied during a special material that captures as cement vertebrae. Most of them are based on a calcium hydroxyapatite, calcium triphosphate or calcium sulfate. However, such "fillers" do not contain proteins of bone tissue, although they can be added to certain substances that stimulate the growth of bone tissue.
At present, surgery to remove an intervertebral disc and adjacent vertebral fixation is increasingly performed endoscopically, without the use of traditional cuts. For that purpose the "ready" systems for spinal fusion: «Pathfinder» (Abbott Spine), «Viper» (DePuy Spine), «Paramount» (Innovative Spinal Technologies), «SphereX», «ATAVI» (Endius), «Sextant System »(Medtronic).
Alternatives to spinal fusion
Currently, there are several treatments that can replace spinal fusion in patients with low back pain.
IDET - elektrotermalnaya intradiscal therapy (annuloplasty). The principle of this procedure lies in the fact that damaged intervertebral disc thin catheter is introduced at the end of which is an electrode. Through it, electrical current is applied, whereby a fibrous ring of intervertebral disc is heated. This leads to a "welding" fiber disc, its strengthening, "stitching" of damage and cracks in the disk that are causing pain. In addition, during this process is coagulation of the nerve endings in the disc, which also reduces their sensitivity and reduces pain. This procedure is suitable only for patients with unexpressed changes in the intervertebral disc, and it is carried out under local anesthesia on an outpatient basis.
The artificial intervertebral disc. The artificial disc, as opposed to fusion, to replace the affected drive and maintain mobility in the spine. The benefits of this treatment method is theoretically as follows:
considered that the preservation of mobility between the vertebrae decreases the risk of premature wear of the vertebrae, it is believed that the use of an artificial intervertebral disc relieves pain better than spinal fusion.
Posterior dynamic stabilization. It uses special devices that reduce the burden on the affected intervertebral disc. This is believed to promote healing of disc injuries and reduces pain.
Regeneration of the disk. Studies of cellular and molecular biology are developing ways to use gene therapy, which would contribute to the restoration of the intervertebral disc.
Indications for spinal fusion, spinal fusion types, bone graft