Spinal Care, Neurology, Spinal Medical Advice and Information.
Refuse to Fuse? New Back Surgeries
By Jae H. Chon, MD
The spine is a very important structure in the human body. It is the pillar of the human body and carries nerves (spinal cord and nerve roots) that communicate between the brain and the rest of the body. It has to be strong to support the body’s weight, rigid enough to protect the nerves, and flexible to allow wide range of motion. The spine consists of bone blocks (vertebra) and connecting joints (disk and a pair of facet joints). Nerves travel through a tunnel within spine called the spinal canal.
Arthritis develops when wear and tear of the disks and facet joints cumulates which can cause neck or low back pain. Arthritis can cause bone spurs to form and the disk to wear out and bulge or break apart (herniation). It can then pinch the nerves as it travels and exits the spine causing leg pain (Sciatica). Arthritis can lead to loosening of the disk and joints and malalignment (spondylolisthesis).
Chronic low back pain and leg pain is usually treated with Tramadol or other conservative methods first. These treatments may include medication, exercise, weight control, physical therapy, chiropractic, acupuncture and steroid injections (Epidural and facet injections). For someone who does not respond to non-surgical treatment, surgical option can be considered.
A bulging or herniated disk (without other complicating issues causing leg pain) can be treated by an outpatient laminotomy and diskectomy. This surgery reduces the bulging of the disk or removes broken off fragments of the disk that are pressing on the nerve causing leg pain.
Bone spurs and bulging disk from arthritis can cause the tunnel where the nerves travel to narrow. This is also referred to as spinal stenosis and can cause low back pain and/or leg pain which is usually made worse with walking and standing, and relieved with sitting. Spinal stenosis, without other complicating issues, may be treated with laminectomy which creates more room for nerves by removing some bone, bone spurs and thickened soft tissue.
Wear and tear of disk and joints may cause loosening of the joints resulting in instability. Instability may cause the spinal canal to not line up causing narrowing and pinching of the nerves resulting in low back and/or leg pain. Instability of the spine and spinal stenosis can be treated with laminectomy and fusion. Fusion is gluing back bones together using bone. Often, screws and rods and/or cages are used to assist in fusion process.
Previously, the treatments mentioned were all of the surgical options available. For those who refuse to fuse, there were no other options, until recently. Now there are alternatives to fusion. Although, these technologies are relatively new, their future appears promising.
One such procedure is artificial disk replacement. In this surgery, a painful and degenerated disk is replaced with an artificial one, similar to a knee or hip replacement. This procedure has been done in Europe for 20 years and was recently approved by the FDA in the United States.
Another procedure is dynamic stabilization. Patients with severe instability would still need to be treated with fusion. But patients with minor instability may now be dynamically stabilized. The Dynesys Spinal System uses flexible materials to stabilize the spine while preserving natural spine structures. During surgery, a small device comprised of a flexible spacer and stretchable cord is attached to both sides of the affected vertebrae. Once in place, the dynamic push and pull relationship between the spacer and cord stabilizes the spine.