Spinal Fusion Surgery

Spinal Fusion Surgery: A Comprehensive Guide to Getting Relief from Chronic Back Pain

The spinal cord is the primary part of your nervous system. It runs from your brain to the lower back of your body. The main function of the spinal cord is to carry messages from your brain to the rest of the body.

A protective bone layer covers the spinal cord, the vertebrae column. The bones present in that column are called vertebrae. Human beings have 33 vertebrae in the spinal cord. A spinal disc is between each vertebrae. Its main job is to cushion the vertebrae and spinal cord.

Unfortunately, some individuals can have their vertebrae dislocated because of certain health problems. This can compress the nerves or spinal cord and cause severe pain and neurological problems. Doctors usually recommend spinal fusion surgery in such cases. It is a medical procedure that connects one or two bones in the spinal cord. 

The surgeon will use bone or bone-like material to fill the space between two bones. He may also use rods or metal plates to hold the bones. The main purpose of spinal fusion surgery is to improve the stability and strength of the spinal cord. 

The surgery is used to treat conditions like herniated discs, degenerative disc disease, spinal stenosis, and spondylolisthesis.

Indications for Spinal Fusion Surgery

Severe back pain due to degenerative changes

Slipped or Herniated Disc

People experience severe back pain when they suffer from degenerative disc disease. It is a condition in which the disc in the spinal cord wears out.

The discs have a soft core, which is mainly comprised of water. But as you grow older, the disc can lose some water content. It will no longer cushion the spinal cord. 

Sometimes, injuries even tear the disc, causing it to lose water content. The disc can move from its place, which is known as a slipped or herniated disc. The nerves near it can get adversely affected. 

Back pain due to Osteoarthritis

The cartilage cushions the bones in the spinal cord. But when the cartilage wears out, it causes severe back pain and swelling. The pain can sometimes become so severe that it can hinder daily activities.

1. Spine instability 

• Spondylolisthesis

Spondylolisthesis occurs when one of the vertebrae in your spinal cord shifts from its position and presses the vertebrae below it. 

This puts pressure on the nerves around it and can cause severe back pain and other health issues like sciatica, numbness, or difficulty walking or standing. Spondylolisthesis can occur anywhere in your spinal cord, but it commonly occurs in the lumbar spine. 

Spinal fusion surgery can prevent further bone slippage and relieve symptoms like back pain and numbness.

• Trauma 

When your spinal cord is severely hit or injured, then it can adversely affect the curvature of the spine. Spinal fusion surgery can help in providing stability to the spine.

2. Correction of Spinal Deformities

• Scoliosis

When you suffer from scoliosis, then there is an abnormal curvature of your spine. The spine takes the curve of a c or s shape. 

You will have severe back pain, leg pain, and difficulty standing. When you suffer from severe spinal curves, it lessens the amount of space in your chest, which can lead to breathing problems.

The doctor recommends spinal fusion surgery to improve stability and reduce pain and discomfort.

• Kyphosis

Kyphosis results when your spinal cord moves outward more than normal. Here, the part of your spinal cord between the neck and ribs moves forward. You will suffer from shortness of breath, balance problems, numbness, and weakness in your legs.

• Lordosis

Your lumbar spine is naturally slightly bent forward. But when it bends more than normal, you have lordosis. This medical condition affects adults over 50 years old or pregnant women.

The doctor first recommends nonsurgical treatments, which are outlined below.

• Physical Therapy

The doctor instructs you to do certain exercises to strengthen muscles around your spinal cord and improve stability.

• Medications

Certain medications are prescribed to treat your spinal problems.

• Injections

Certain injections can be given to reduce pain, discomfort, and inflammation.

When all these approaches fail, then the doctor recommends spinal fusion surgery.

The Surgical Procedure

Before undergoing spinal fusion surgery, your doctor will recommend certain tests. For example, you will have certain physical tests to ensure that you are completely ready for the surgery. Physical tests include blood pressure, heart monitoring, and blood tests. 

Again, an MRI and CT scan will be done to get a detailed image of your spinal cord. It will help the doctor determine the exact problem with your spine and its curvature, and accordingly, he will plan the surgery.

Inform your healthcare provider about the medications you take, including herbal medicines. Again, follow the instructions in your prescriptions as directed. This can help you recover faster after the surgery.

If you use tobacco, then your doctor will instruct you to avoid it before and after the surgery strictly. Nicotine can obstruct your body’s ability to heal properly.

You will have restrictions for lifting or driving immediately after the surgery. Ensure that your family member or friend is here with you for a few days after the surgery to help you in daily activities or assist you in various things. 

Your doctor will explain the surgery and its recovery time. You will be instructed to stop eating and drinking a few hours before the surgical procedure.

Surgery Descriptions

There are usually two types of surgical techniques performed for spinal fusion surgery.

1. Open Surgery

Here, the doctor first gives general anaesthesia and then makes a large incision of around 6 inches in your back to access the affected spine region.

The complications of open surgery are high here, like blood loss and infection. You will take a longer time to recover when you have open spinal surgery.

2. Minimally Invasive Surgery

Your surgeon will give you anaesthesia so that you will be asleep during the entire surgical procedure. Afterwards, the surgeon will make one or two small incisions near the spinal cord. 

He will use a tool to sideways the muscles near your spinal cord and access the affected area. He will then remove the disc and place a bone-like material in its place. Sometimes, the disc remains in its place, and the bones are fused on both sides.

Minimally invasive surgery has fewer complications compared to traditional open surgery. The recovery time is even faster here. 

Advantages

• The surgeon makes small incisions.
• Quicker recover
• Short hospital stay 
• There is less damage to muscles.

Disadvantages

• The surgeon will not have direct access to the spinal cord.
• Specialized equipment is necessary for this procedure, which may not be available in all hospitals.

In both surgery techniques, the surgeon harvests bone grafts from either your pelvic area or from your spine. There are even synthetic bone grafts available that the surgeon uses to fuse vertebrae in your spinal cord.

The surgeon uses hardware like screws, rods, or plates that will hold affected vertebrae in place. It restricts the motion of the affected vertebrae and ensures proper healing.

The length of the surgery depends on various factors, such as the number of vertebrae being fused, the harvesting bone graft procedure undertaken by your surgeon and more. Typically, the surgical procedure will take 2 to 5 hours.

The patient will be required to stay in the hospital for two to five days. Minimally invasive surgery generally requires a shorter hospital stay.

Types of Spinal Fusion

Spinal fusion surgery can be performed through various techniques. They are listed below.

Anterior Spinal Fusion Surgery

In anterior spinal fusion surgery, the patient has to lie on his back. The surgeon makes an incision on the front of the body.

He makes an incision either on your abdomen (luman fusion surgery) or on the front of the neck (cervical fusion surgery). 

The surgeon then aside all the muscles to access the affected area. He removes the damaged disc and places the bone graft in its place. Screws or rods can be used to stabilize the affected vertebrae in the spinal cord.

It is a complex surgery. There is a risk of damage to the blood vessels or internal organs.

Posterior Spinal Fusion Surgery

Here, the surgeon will access the spinal cord from the patient's back. This means that an incision will be made on the back of the body. 

The surgeon then moves aside blood vessels and muscles to access the spine. He removes the affected disc and replaces it with a bone graft. Screws or rods are used to provide stability to your spine.

It takes a long time to recover as there is more muscle and tissue disruption.

Harvesting Bone Grafts

The bone graft used in surgery is known as spinal arthrodesis. The bone is taken from some part of the body, or bone-like material is placed between the vertebrae to create a solid bone bridge-like structure. The additional bone will provide rigidity to the affected vertebrae.

Various bone graft materials can be used in spinal fusion surgery. They are outlined below.

• Autograft

Here, the bone is taken from the patient’s own body, specifically the iliac crest, which is part of the pelvic area.

However, removing bone from other areas of the body requires additional incisions, which can lengthen the recovery process.

The bone removed from the pelvic area has certain advantages, such as containing cells and proteins to increase bone healing. However, it comes with certain limitations, which are listed below.

• It hurts when the doctor removes bone from your pelvic area.
• There are only limited bones in your iliac crest.
• Removing bone from the iliac crest can lead to fracture.
• Infection or bleeding can occur in the iliac crest site.

Today, new technologies are emerging year in and year out, so the autograft technique is now less used. However, the surgeon still uses it in a few cases, like patients with high risks, those who smoke a lot, or have any other factor that can inhibit the healing process. 

• Local Bone Autograft

Here, the surgeon harvests the bone from the surgical site, which is taken from your spinal region. The harvested bone helps to fuse the vertebrae.

This process has various advantages, which are listed below.

• No incision is required in other parts of your body, so there is additional pain compared to the autograft method.
• The graft has all the properties that are necessary for the formation of new bone.

However, the procedure has certain limitations, such as the small size of the spinal bone. There is only limited bone availability for the fusion procedure.

• Allografts

Here, the bone is taken from a living donor who has recently undergone hip replacement surgery or from a dead human being. 

This procedure is known as an allograft grafting procedure. The bone taken from a living or dead donor will not develop into new bone. It will allow a scaffold, which means it will be a surface that allows the new bone to form on your spinal region. 

There are various benefits of this procedure, such as the donor's bone having a lower risk of spreading infections. 

• Synthetic bone grafts

Synthetic bone grafts are man-made materials that are used in spinal fusion surgery. These materials are made from ceramic materials like calcium phosphate. These materials are readily available.

Hence, there is no need for additional incision in any other areas of the body during the spinal fusion surgery.

The synthetic bone material has the same shape and consistency as that of the autograft bone.

• Bone Marrow Aspirate

Bone marrow is present at the centre of the long bones in your body, like the bones in your arms, legs, or thighs. It contains stem cells that can form new bone. 

The surgeon draws stem cells from the bone marrow just like blood is drawn from a patient's body. These stem cells are then combined with another type of graft, like synthetic bone graft, autograft, or allograft, to speed up the fusion procedure. 

Research is still being done on this type of procedure. Older adults can face problems with this type of bone graft harvesting procedure because they have fewer stem cells in their bone marrow area.

• Biologics or proteins

Our body produces proteins to stimulate bone growth. One such protein is bone morphogenic protein (BMP), which can be used for vertebrae fusion. BMP's main advantage is its ability to form new bones.

Some studies about this procedure say that BMP is safe for human beings. However, there are even studies that show that BMP can lead to excess bone formation or it can increase the chances of cancer.

Benefits of Spinal Fusion Surgery:

Spinal fusion surgery has numerous benefits, which are listed below.

• Degenerative disc disease or spondylolisthesis can cause severe back pain. Spinal fusion surgery can greatly help relieve chronic back pain. There is a significant improvement in the quality of life. The patient can do all normal activities like walking, bending, lifting, swimming, and cycling without any issues.
• Spinal fusion surgery stabilizes the affected vertebrae by preventing their motion. Thus, the surgery prevents the additional wear and tear of the nearby vertebrae or disc.

Risks and Complications:

Spinal fusion surgery is absolutely a safe surgery. But it comes with certain complications.

• Infection at the surgery site
• Excess bleeding can happen during the surgery.
• Nerve injury, which can result in pain and weakness.
• The patient can suffer from pseudoarthrosis. It means the bones will not fuse properly because of factors like excess smoking or certain medications.
• The screws or rods may lose or break after the surgery.

You choose the surgeon wisely. An experienced and skilled surgeon can handle complicated cases and reduce the risk of the surgery as much as possible.

Again, a highly skilled surgeon will properly evaluate your physical health and bone quality and better access the spinal cord through MRI and CT scans. He will choose the best surgery approach that suits your body.

Patients should even be aware of certain long-term considerations, like adjacent segment disease. In this disease, the vertebrae above and below the fused vertebrae can experience stress or wear out with time.

Some patients can even experience chronic pain or stiffness in their back or neck region even after the surgery.

Try to adopt a healthy lifestyle and quit smoking to minimize the risks associated with the surgery.

Recovery and Rehabilitation:

Recovery from spinal fusion surgery will require time and patience. The healing period depends upon various factors, like the number of vertebrae fused, the surgical approach, and your health condition.

You have to stay in hospital only for 2–3 days. The doctor and nurse monitor your entire health condition and complications like infection on the surgical site.

If you do not have any complications, then you will be discharged from the hospital. You may have pain or swelling at the surgical site. Your surgeon will prescribe certain medications to manage the pain. 

You need to avoid bending, lifting, or doing strenuous activities immediately after the surgery. Regular follow-up is essential after the surgery to monitor the healing process.

The patient will completely recover after 6 months of the surgery. During this time, the patient can do some light work, like walking, to enhance blood circulation in the body and speed up the recovery process.

Physical therapy is even more important during the recovery process. It focuses on gentle exercises that help strengthen muscles, improve blood circulation, prevent blood clots, and increase mobility without putting much stress on the spine. 

Post-operative care instructions should be followed strictly to ensure proper healing. Some of the instructions given by your doctor are listed below.

• You should not bend or lift heavy objects for a few months after the surgery.
• Strictly avoid smoking as much as possible.
• Eat a nutritious diet after the surgery.
• Wear a spinal brace if prescribed by your doctor.
• Resume normal activities slowly after the surgery.

Medical Tourism for Spinal Fusion Surgery

The demand for medical tourism is gaining popularity today. This is because healthcare costs are quite high in developed countries. Patients have to wait a longer time for spinal fusion surgery. The delay can deteriorate their health condition. 

The surgery cost is too high, and many patients cannot afford it. Hence, they choose medical tourism destinations like India, Turkey, and Thailand. These destinations have hospitals that are equipped with advanced technologies. The doctors are renowned and highly skilled. 

They have performed numerous spinal fusion surgeries to date. Spinal fusion surgery can be done at a fraction of the cost compared to the cost in developed countries.

However, you need to keep a few things in mind before choosing an international hospital. We are listing them below.

• Choose a hospital that NABH accredits.
• Check patient reviews and hospital references.
• Choose a hospital that is equipped with advanced technology.
• Do research on the experience and expertise of surgeons. 

Racure Healthcare is one of the best medical tourism companies. The company arranges virtual meetings with the surgeon before arrival at your medical tourism destination. It assists you in booking flights so that you can have hassle-free travel. Contact us today to learn more about Racure Healthcare and its services.

Cost of Spinal Fusion Surgery

The cost of spinal fusion surgery in the United States is $100,000 to $150,000. But in India, it is between $1500 and $7710. The cost of the surgery in Turkey is $10,000 to $18,000.

Various factors influence the overall cost, like the type of hospital you choose in a medical tourism destination, surgeon expertise, and the type of fusion technique used in surgery.

There are even some additional costs, like follow-up care and accommodation in the medical tourism destination.

Conclusion

Spinal fusion surgery is a boon for patients suffering from spinal instability, severe back pain, or abnormal curvature in the spine. The surgery can improve patient’s life, and he can do all the normal activities like walking or swimming without any hassle.

Medical tourism destinations can be a great solution if you want high-quality medical care at an affordable cost.

Racure Healthcare Medical Tourism Company appoints a personal care executive for every patient. If you have any queries regarding treatment, stay, or travel, you can call anytime to clarify them.