Spinal Fusion

Spinal fusion is a surgical technique to stabilise a mechanically unstable segment of spine, which is causing pain,deformity or neurological compression. Mechanical Instability in spine often is the leads to symptoms like back pain, leg pain, claudication or spinal deformity. A spinal fusion surgery is designed to stop the motion at a vertebral segment, which in turn should decrease pain or correct deformity. Spinal fusion surgery is designed to create solid bone between the adjoining vertebra, eliminating any movement between the bones. The goal of the surgery is to reduce pain and nerve irritation and correct deformity like scoliosis or kyphosis.

There are many approaches to lumbar spinal fusion surgery, and all involve the following process :

• Adding bone graft to a segment of the spine
• Set up a biological response that causes the bone graft to grow between the two vertebral elements to create a bone fusion
• The bony fusion - which results in one fixed bone replacing a mobile joint - stops the motion at that joint segment

Indication of spinal fusion :-

• Spondylolisthesis (isthmus, degenerative, or postlaminectomy spondylolisthesis)
• Degenerative disc disease, Slip Disc , Herniated Disc , Prolapse Intervertebral Disc (PID) Complex Spinal Stenosis
• Mechanical instability due to Spinal Trauma/ Spinal Tumor / Spinal Metastasis
• Unstable spine due to spinal infection eg Tuberculosis
• Unstable spine due to Spinal Deformity- Scoliosis or Kyphosis

Spinal Fusion can be performed in different ways , in different locations of spine by different approaches.The various options in spinal fusion are

• Anterior approach
  • Cervical Spine - Anterior Cervical Diskectomy & Fusion (ACDF)
  • Lumbar Spine - Anterior Lumbar Interbody Fusion (ALIF )
• Lateral Approach - Extreme Lateral Interbody Fusion (XLIF)
• Posterior Approach
  • Lumbar Spine
    • PLF - posterolateral Inter transverse Fusion
    • PLIF - posterior Lumbar Interbody Fusion
    • TLIF - Trans Foramina Interbody Fusion
  • Thoracic Spine
    • PLF - posterolateral Fusion
  • Cervical Spine
    • Posterolateral Fusion
    • Interfacetal Fusion

Inter body Fusion Advantage over Inter transverse:-

• 360 degrees fusion through single posterior approach
• Load sharing support to posterior instrumentation
• Possibility of 'jacking' open the root canal / restoring disc height
• Restores sagittal alignment