Minimally Invasive Spinal Fusion Surgery at India

         Minimally Invasive Spinal Fusion Surgery in India

Spinal fusion (spondylodesis or spondylosyndesis) is the surgical method of joining two or more verebrae. It is done most commonly in the lumbar region of the spine, but it is also used to treat cervical and thoracic problems. In this procedure, the damaged and painful vertebrae are fused into a solid stable bone. Fusion of the spine is used primarily to eliminate the pain caused by abnormal motion of the vertebrae by immobilizing the faulty vertebrae themselves, which is usually caused by degenerative conditions. However, spinal fusion is also the preferred way to treat most spinal deformities, specifically scoliosis and kyphosis. But, the results may vary according to the individual. Some may not feel any improvement in their back pain even after the surgery.

                        Types of Spinal Fusion Surgery

• Posterolateral Fusion : In the back of the spine, the bone graft is placed in amid the transverse processes. With the help of wires and screws, the vertebrae is carefully fixed throughout the particles of every vertebrae. A rod is made up of metal which is attached on the side of vertebrae.

• Interbody Fusion : In this, the graft of the bone is placed in between the vertebrae and the area is generally engaged by the intervertebral disc. The disc is entirely removed in preparing for the spinal fusion. In order to maintain the disc height and spine alignment, a device can be placed in between the vertebrae. This device (intervertebral device) can either be prepared from titanium or plastic.

                       Advantages of Spinal Fusion Surgery

• By fusing the level, there is less concern that the patient will need surgery again at that level. If the discs and/or facets are pain generators, as is often the case, a fusion will ensure that motion at the level is stopped, potentially eliminating the low back pain.

• A second advantage of spinal fusion surgery is that it reduces post-decompressive deformity. Some patients develop post-laminectomy kyphosis, which is an abnormal alignment of the spine. This too can often lead to additional surgery. Similarly, a fusion can correct any deformity the patient had before surgery and ensure that the normal alignment of the spine is restored. This may reduce wear and tear (and need for future surgery) on the neighboring levels.

   Procedure for Posterior Lumbar Interbody Fusion (PLIF)

PLIF surgery aims at achieving spinal stability through bony fusion by two ways:

The Open PLIF is the traditional technique which is performed using general anesthesia. The patient is made to lie down on his front side on the table with the low back exposed. A 3-6 inch long incision is made on the skin overlying the affected vertebrae. The skin and the fascia are cut open. The underlying muscles are retracted and the affected vertebrae are identified. 

Fluoroscopic X-ray is used to confirm the exact location of the affected vertebrae. Then a complete laminectomy (removal of the lamina of the vertebrae) followed by bilateral foraminotomy (enlargement of the foramen by removing the bony spurs) and/or discectomy (removal of offending disc) are performed.

This relieves the compression off the spinal nerves, allowing them to come to their normal size and shape. The area is checked for any remaining bony outgrowth or disc fragments that may compress the nerves. Autogenic bone grafts or Metal or plastic implants are fitted in the empty disc space for initiating bone growth.