Spinal fusion is a surgical procedure in which two or more vertebrae are joined or fused together using bone graft or metal implants or most commonly both. Bone graft may be from the patient (autograft), a donor (allograft), or bone morphogenetic protein (BMP).
Fusion surgery is commonly performed to treat disorders such as degenerative cervical disc prolapse, scoliosis (abnormal curvature of the spine), spondylolisthesis (abnormal movement of one vertebrae over the other), and fractures of the spine.
Fusion of the spine may be done to fuse the vertebral bodies situated anteriorly or the posterior part of the spine i.e. intertransverse and inter facetal fusion. Cervical inter body fusions are done from the front of the spine (anteriorly) for conditions like disc disease, OPLL, tumors, infections (commonly Tb) and trauma, where tissue / bone compressing the spinal cord is removed and bone graft and implants are used to fuse the spine.
Lumbar inter body fusion can be done from the front (anterior) and back of the spine (posteriorly). Examples of anterior fusion surgery are ALIF) and posterior fusion are PLIF, TLIF.
Anterior Lumbar Interbody Fusion (ALIF)
Posterior Lumbar Interbody Fusion (PLIF)
Transforaminal Lumbar Interbody Fusion (TLIF)
CASE STUDY 1
A 46 years old lady with a history of neck pain with left arm pain and numbness for two months.
Procedure : C5-C6 anterior cervical microdiscectomy and fusion under general anesthesia (1/3/2017)
Pre-op MRI (herniated disc at C5/6 encircled)
Post –op X-ray (circled - PEEK cage inserted in the disc space
CASE STUDY 2
A 71 old gentleman, was admitted with complaints of difficulty in walking and standing and weakness of right grip since a fall. He was investigated with MRI of the cervical spine which revealed a C5-C6 disc prolapse and antero-listhesis and myelomalacia of the cord at that level.
Procedure: C5-C6 anterior cervical microdiscectomy and stabilization using PEEK cage and anterior cervical plate.
X-Ray post-op showing percutaneous pedicle screws
Post op X-ray (encircled - the cervical plate over a PEEK cage)
CASE STUDY 3
A 43 year old overweight male (110Kg) presented with complaint of low back pain for 6 years. He was diagnosed to have discogenic back pain arising from the L4-L5 disc. He underwent X-ray, MRI and finally lumbar discography which confirmed that his pain was arising from the L4-L5 disc. Because of the severe disc degeneration and being overweight, he was not a candidate for artificial lumbar disc replacement. We therefore chose to fuse his spine at L4-L5 both anteriorly and posteriorly (ALIF and posterior pedicle screw stabilization) following spine stabilization, he relieved of his low back pain.
Pre-op MRI Images
Pre-op Image of discography showing contrast
escaping from the disc into the L4 body
Post-op X-ray Image showing metal implants in place