The spinal segment is the basic functional unit of the spine. It consists of two adjacent vertebrae, the intervertebral disc and all the associated ligaments that hold them and allow them mobility.

The deterioration of one or more vertebral segments due to degenerative, traumatic, infectious or tumoral reasons may cause:

1. Spinal pain by changes in the spinal biomechanics (instability / deformity)
2. Vertebral pain due to segment degeneration (joint / disc)
3. Neural cord compression or stenosis (narrowing) of the spinal canal

Arthrodesis is the rigid and irreversible immobilization of one or more vertebral segments to relieve pain and prevent or treat spinal instability. It may be associated with the channel decompression if necessary.

Benefits of intervention

The goal of fusion is to stabilize the spine in order to relieve local pain. In addition, the nerve root decompression relieves sciatic pain and the difficulties in walking typical of stenosis.

In case of spinal cord injury, symptoms such as weakness or numbness may take time to recover or remain as sequelae, depending on the degree of damage already established.

Medical-technical description

ANTERIOR CERVICAL FUSION: minimally invasive approach using transverse incision in the anterior neck. Disks are replaced by implants or bone from the patient. Bolted plates are often used to correct the curves.

POSTERIOR CERVICAL FUSION: more aggressive approach with longitudinal incision in the back of the neck. Decompresses the spinal canal and the cervical nerves without handling the disks. Screws and rods are used for fixing.

THORACIC / LUMBAR POSTERIOR ARTHRODESIS: standard approach to the canal decompression and fixation with pedicle screws and rods, usually made of titanium. Bone graft is used from the patient, but it can be synthetic as well.

XLIF (Xstreme Lateral Interbody Fusion): minimally invasive lateral approach to the lumbar spine. It respects all structures of the healthy spine. It is needed to thwart the psoas muscle, which can cause more or less transitory weakness in the leg. It is not possible in L5-S1.

Axia-LIF: percutaneous approach specifically designed for L5-S1.

OLIF (Oblique Lumbar Interbody Fusion): oblique approach to the lumbar spine, minimally invasive, with few risks, but only valid from L2 to L5

ALIF: anterior approach to the lumbar spine. Higher guarantees of interbody fusion. Higher vascular risk than other approaches.

Intervention

Spinal fusion surgery is performed under general anesthesia. The usual duration of this intervention is between 1 and 5 hours depending on the type of approach and the region intervened, while the patient remains in the operating room and recovery room between 3 and 7 hours. The patient will be hospitalized between 1 and 10 days.

Preoperative measures

• Assessment prior consultation, deciding and stating the specific aspects of the intervention and giving informed consent
• Conducting a preoperative evaluation consisting of a blood test, biochemistry, coagulation, chest radiograph and ECG
• Do not drink alcohol or smoke 48 hours prior to the intervention
• If surgery is scheduled for the morning, you shouldn’t eat anything before. If it is in the afternoon, have breakfast early and do not eat or drink 9 hours before surgery
• Do not wear any metal objects during operation (rings, bracelets, earrings, piercings, etc.)

Postoperative cares

• Drains will be removed 24-48 hours after surgery
• Usually, movement starts from the first day after the intervention

When turning in bed you will require some help. Sleep preferably in a side position.

Use of bracing after the intervention

1. In the case of a thoracic or lumbar fusion of any kind, you will be asked to use a brace for 2 months, except for sleeping
2. In the cervical arthrodesis it is not necessary to use braces, unless your doctor specifically instructs you to.

Restriction of postoperative mobility

1. After a thoracic or lumbar fusion, the following days after surgery, you should walk but avoid getting tired. You’ll notice that you can gradually increase the distance. Use straight-backed seats to sit while wearing corsets
2. After a cervical fusion, the neck must be moved normally, not sharply

After discharge:

1. Avoid lifting weights for 2 months, bending, stooping or any awkward posture of the spine; sports, housework or driving
2. Contact us if you have chest pain or shortness of breath, weakness in limbs, fever and chills processes or oozing from the wound

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