Anterior Spinal Fusion

Spinal fusion is a surgical procedure in which two or more vertebrae are joined together, eliminating any movement between them. This procedure is performed by placing bone grafts or bone graft substitutes in between the affected vertebrae to promote bone growth and eventually fuse the vertebrae into a single, solid bone. Spinal instrumentation or implants such as rods, plates, screws, and interbody devices are used to stabilize the spine after fusion.
In anterior spinal fusion, the spine is approached from the front.

The common types of anterior spinal fusion procedures include:

  • Anterior Lumbar Interbody Fusion (ALIF)
  • Anterior Cervical Discectomy with Fusion (ACDF)
  • Anterior Cervical Decompression and Fusion
  • Anterior Cervical Corpectomy and Fusion

Anterior Lumbar Interbody Fusion (ALIF)

Anterior lumbar interbody fusion (ALIF) is a surgery performed to correct the spinal problems in the lower back. The surgery can be implemented either as an open surgery or minimally invasive technique.

Indications

The common indications of ALIF are:

  • Severe lumbar (low back) or leg pain that is unresponsive to non-surgical treatment.
  • Degenerative disc disorder of lumbar spine (pain due to damaged disc)
  • Spondylolisthesis (slippage of one vertebra on another)
  • Scoliosis (S-shaped curve of spine)
  • Fractures of spine
  • Tumors
  • Spinal instability

Surgical procedure

The ALIF surgery is usually performed under general anesthesia. The patient is positioned supine lying on the back. The surgeon makes an incision in the abdomen and retracts the muscles and various structures to enhance the clarity and accessibility to the anterior aspect of the vertebrae. The surgical approach is from the front of the vertebral body in the low back region. Your surgeon removes the whole disc or a part of the damaged disc between two adjacent vertebrae followed by fusion of the same with or without the use of bone grafts. External implant materials such as rods, screws, plates, and wires may be fixed to the treated vertebrae to deliver extra support and stability during the healing process. At the end of the procedure, the structures are re-approximated and the skin is closed with sutures.

The success of surgery depends on various factors such as age, spinal condition, overall health status, and activity level of the individual.

Recovery

The recovery period after ALIF surgery depends on the body’s healing capacity. The post-surgical hospitalization includes a rehabilitation program. Your surgeon may prescribe pain medications or a brace and follow-up physical therapy upon discharge.

The period of your rest or inactivity depends on a few factors such as the type of surgical procedure and the approach used to access your spine, the size of the incision and presence of any complications. Return to work or normal activity depends on the type of work or activity you plan to perform. Usually 3 to 6 weeks is the ideal time for healing. With advanced and innovative techniques, it is now possible to achieve improved fusion rates and shorter hospital stays with an active and rapid recovery period.

Strictly adhere to the post-operative instructions suggested by your spine surgeon to promote healing and reduce the possibility of post-operative complications.

Risks or complications of ALIF surgery

The complications of the ALIF surgery include infection, nerve damage, blood clots, blood loss or bowel and bladder problems and any problems associated with anesthesia. The underlying risk of spinal fusion surgery is failure of the fusion between vertebral bone and bone graft, which usually requires an additional surgery.
Talk to your spine surgeon if you have any concerns or queries regarding ALIF.

Anterior Cervical Discectomy with Fusion (ACDF)

Anterior cervical discectomy with fusion is an operative procedure to relieve compression or pressure on nerve roots and/or the spinal cord due to a herniated disc or bone spur in the neck.

In anterior cervical discectomy with fusion, the surgeon approaches the cervical spine through a small incision in the front of the neck and removes the total disc or a part of the disc along with any bony material that is compressing or putting pressure on the nerves and producing pain. Spinal fusion implies placing a bone graft between the two affected vertebral bodies encouraging bone growth between the vertebrae. The bone graft acts as a medium for binding the two vertebral bones, and grows as a single vertebra that stabilizes the spine. It also helps to maintain the normal disc height.

Indications

Herniated disc is a condition in which the soft, gel-like center of the disc (nucleus pulposus) bulges out through the damaged or broken disc’s tough, outer ring (annulus fibrosus). Bony out growths known as bone spurs or bone osteophytes may be formed due to the accumulation of calcium in the spine joints. The pressure induced by a herniated disc or bone spur on nerve roots, ligaments or the spinal cord may cause pain in the neck and/or arms, numbness or weakness in the arms, forearms or fingers, and lack of coordination.

As most nerves to the body (e.g., arms, chest, abdomen, and legs) pass through the neck region from the brain, pressure on the spinal cord in the neck region (cervical spine) can be very problematic. Patients with these symptoms are potential candidates for anterior cervical discectomy procedure but only after non-surgical treatment methods fail. Cervical discectomy can reduce the pressure on the nerve roots and provide pain relief.

Before recommending surgery, your surgeon considers several factors such as your health condition, age, lifestyle and anticipated level of activity following surgery. A thorough discussion with your surgeon regarding this treatment option is advised before scheduling the surgery.

Procedure

Your surgeon makes a small incision in the front side of the neck and locates the source of neural compression (pressure zone). Then, the intervertebral disc that is compressing the nerve root will be removed. Afterwards, a bone graft will be placed between the two vertebral bodies. In certain instances, metal plates or pins may be used to provide extra support and stability, and to enhance the fusion of the vertebrae.

Recovery

A specific post-operative recovery/exercise plan will be given by your physician to help you return to normal activity at the earliest. The duration of the hospital stay depends on this treatment plan. You will be able to walk by the end of the first day after the surgery. You should be able to resume work within 3-6 weeks, depending on your body’s healing status and the type of work/activity that you plan to resume. Discuss with your spinal surgeon and follow the instructions for optimized healing and appropriate recovery after the procedure.

Risks &Complications

Treatment results are different for each patient. In addition to the anesthetic complications, spinal surgery is associated with some potential risks such as infection, blood loss, blood clots, nerve damage, and bowel and bladder problems. Failure to fuse the vertebral bones with the bone graft (fusion failure) is an important complication of spinal fusion which requires an additional surgery.

Please take your physician’s advice for a complete list of indications, clinical results, adverse effects, warnings and precautions, and other relevant medical information about the anterior cervical discectomy with fusion surgery.

Anterior Cervical Decompression and Fusion

Cervical decompression and fusion is a surgical procedure to remove pressure from the spinal cord and/or nerve roots by reconstructing the upper part of the spinal cord.

Cervical decompression is performed by making a small incision in the front part of the neck. The fusion can be done by bone grafting where the grafting material is collected either from a different body part of the same patient or from a donor. Spine surgeons prefer the anterior approach because it provides better access to the site of injury. This procedure is performed to reduce deformity and stabilization, minimizing neurological injury and early rehabilitation of the spine.

Anterior cervical decompression procedure may be combined with a spinal fusion procedure. This involves additional placement of bone grafts between the affected vertebrae to stimulate the growth of bone to fuse the two vertebral bodies. The placed graft material acts as binding agent and helps to retain the normal height of the disc. With time, the bone graft ultimately grows to join and stabilize the affected vertebrae.

Anterior Cervical Corpectomy and Fusion

An anterior cervical corpectomy and fusion is an operative procedure to relieve pressure on the spinal cord and spinal nerves by removing the vertebral bone and intervertebral disc material (decompression) in the cervical spine, or neck.

Anterior cervical corpectomy involves removing the vertebral bone or disc material by approaching the cervical spine from the front side (anterior position) of the neck. Spinal fusion implies placing a bone graft between the two affected vertebral bodies, encouraging bone growth between the vertebrae. Spinal fusion helps in achieving adequate decompression of the neural structures. The bone graft acts as a medium for binding the two vertebral bones, and grows as a single vertebra which stabilizes the spine. It also helps to maintain the normal disc height.

Indications

Degenerative spinal conditions like herniated discs and bone spurs result in spinal nerve compression. In addition, spinal fractures, infection or tumors may also put pressure on the spinal nerve structures. Nerve compression in the neck region (cervical spine) can cause neck pain and/or pain, weakness or numbness that radiates down to the arms. Your surgeon recommends anterior cervical corpectomy and fusion surgery after examining your spine, obtaining your medical history, and reviewing imaging results of cervical vertebrae such as X-ray, CT (computed tomography) scan or MRI (magnetic resonance imaging). Surgery is recommended only after non-surgical treatment approaches fail. Before recommending surgery, your surgeon considers several factors such as your health condition, age, lifestyle and anticipated level of activity following surgery. A thorough discussion with your surgeon regarding this treatment option is advised before scheduling the surgery.

Procedure

Your surgeon makes a small incision at the front of your neck slightly to the side and locates the source of neural compression. Then, the vertebral body or intervertebral disc that is compressing the nerve root will be removed to relieve the compression. Afterwards, a bone graft will be placed at the site of decompression. In addition, instruments such as plates and screws are used to provide additional support and stability and to ease healing and fusion of the vertebrae.

Recovery

A specific post-operative recovery/exercise plan will be designed by your physician to help you return to normal activity at the earliest. After surgery, your symptoms may improve immediately or gradually over the course of time. The duration of the hospital stay depends on the treatment plan. You will be able to walk by the end of the first day after the surgery. You should be able to resume work within 3-6 weeks, depending on your body’s healing status and the type of work/activity that you plan to resume. Discuss with your spinal surgeon and follow their instructions for optimized healing and appropriate recovery after the procedure.

Risks or Complications

Treatment results and outcomes are different for each patient. All surgeries carry risk and it is important to understand the risks of the procedure in order to make an informed decision to go ahead with the surgery. In addition to the anesthetic complications, spinal surgery is associated with some potential risks such as infection, blood loss, blood clots, nerve damage, and bowel and bladder problems. Failure to fuse the vertebral bones with the bone graft (fusion failure) is an important complication of spinal fusion which requires an additional surgery.

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