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The
most common reason to
fuse two vertebral bodies together is intractable back or neck pain related
to disc degeneration and/or instability.
As all people age, the discs begin to degenerate. However, in some people,
a rapid progression of degeneration may occur either due to an acceleration
of this process or due to some traumatic injury or muscle imbalance. Genetics
often play a major role in the age of onset and severity of disc degeneration. A fusion of the spine may be performed if a patient has failed extensive nonoperative management and has severe limiting back pain. All patients should undergo nonoperative management consisting of time, medications, exercise, rest and activity modification. If the pain remains severe and limiting as well as impairing the quality of life, a fusion may be the answer. |
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With modern surgical techniques,
the success rate of spinal fusion has risen greatly. Instrumentation,
with rods and screws, is commonly used to act as an 'internal cast' to stabilize
the vertebra until the fusion, or the re-growth of bone, can occur. Without
instrumentation, there
is a small chance of a graft dislodgment or extrusion. Fusion
rates were as low as 40% and sometimes required additional surgery to
reinsert the bone graft, and instrumentation. However,
with modern instrumentation and smoking cessation, we experience fusion
rates of greater than 90%. |
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 Classically,
fusions for severe intractable backpain related to disc degeneration and/or
instability produce the best results if they can be limited to one or two levels.
Rarely, more than two levels (three vertebral bodies) may be attempted to be
fused; however, the results become less predictable as more levels are included.
The ideal candidate for spinal fusion is an individual between the ages of
35 and 65, who has severe back or neck pain that impairs the quality of life
and the patient has failed nonoperative treatment. 
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If the disc collapse
or narrowing also leads to nerve impingement, this patient may also have some
degree of leg or arm symptoms from spinal stenosis or nerve compression. This
is pinching of a spinal nerve as it leaves the spinal canal, producing radiating
pain, numbness or weakness. |
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 An
individual who has a gross motion or slippage between the vertebral bodies
may also be a candidate for a fusion if one or two levels can clearly be defined
as the source of the problem. Spondylolisthesis is the forward slippage of
one vertebra on the adjacent vertebra and may lead to severe pain requiring
a fusion. As always, there are variations of the classic indications and, depending
upon the surgeon's expertise, he or she may elect to perform a fusion for individualized
medical reasons beyond the above mentioned conditions. |
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Autograft To achieve an autograft, the patient’s own bone is harvested from the hip. This technique is common and has been in use since the 1950’s. With an autograft, 90%-95% of patients will achieve a fusion. The principal disadvantage with using autograft bone is that another incision needs to be made over the hip to harvest the bone graft. Possible complications associated with the autograft can include chronic pain, infection, hip fracture, bleeding, or damage to the nerve that supplies sensation to the front of the thigh. The chances of a complication increase with the size of the bone graft. Many patients find the bone harvest site to be more painful than the fusion surgery itself. |
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Allograft As an alternative, allograft bone, donated from a cadaver can be used. Allograft bone eliminates the need to harvest the patient’s own bone. Basically, the donor bone graft acts as a calcium scaffolding in which the patient’s own bone grows and eventually replaces. There are no cells in the bone graft, so there is no chance of a graft rejection.This process, called "creeping substitution", is slower to heal than an autograft bone fusion, but yields equivalent fusion rates as autograft bone while avoiding some of the potential complications. |
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| BMP
- A Breakthrough in Fusion Technology There is now a new technology available for spinal fusion called BMP, for Bone Morphogenetic Protein. BMP occurs naturally in the human body and promotes bone growth by converting blood cells into bone cells. In this technique, the patients own bone rapidly fills the fusion site without the potential complications of a second bone harvest surgery. This breakthrough technology is quickly gaining wide acceptance as the best option available for fusion surgery. Read more about BMP... |
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