Emerald Coast Pain Services


Spinal Fusion Surgery

What is a spinal fusion? It simply implies that a segment of the spine is fused and made rigid. There are various ways to do this. The fusion can be done with only bone. The bone may be from a cadaver or your pelvic crest. In either case the bone is packed into the joint regions of the spine to allow the bones to fuse. Most modern fusions include some degree of metal hardware. They may also include bone as well. The metal hardware can be a screw and rod type which looks like an "errector set" or a cage type which is a round cylinder inserted into the space between the bones (where the disc is) and this holds the bones apart. There are other variations such as the plate which is often used in the cervical area.  In recent years fusions have become popular with surgeons. There are various reasons why this is. Some say it is because the fusion is "definitive" treatment. Meaning that if it works, wonderful bit if it doesn't then there isn't anything else that can be done. Some say it is because the surgeons get paid two to three times the amount to do a fusion versus a regular decompressive surgery such as a laminotomy. Others claim that it is because todays surgeons are not only taught this approach but the hardware manufacturers really push the surgeons to utilize these devices. Whatever the reason, fusions are the mainstay of treatment but in many cases, a decompressive surgery such as a laminotomy or discectomy can resolve the problem with fewer long term issues. What are the long term issues? The fusion leads to increased motion above and below the fusion. this leads to decay of the joints and discs above and below the fusion. As the discs decay they herniate and now a patient may need a repeat surgery to correct the new problem. this often means extension of the fusion. We personally think fusions are over-utilized and that most problems could be addressed via a conventional decompressive procedure where the pressure on the spinal cord is reduced by removing bone and disc. The success rates for fusions run betwen 50 to 70% good to excellent. That means that up to 70% of people get 50 to 100% relief of their pain. The success rates for the decompressive surgeries are similar and if the decompressive surgery doesn't work, you always have the option of getting a fusion while the reverse is not true. The important thing to realize is that 30% of people undergoing spinal surgery do not get better! This is why pain management doctors are so busy! This is why we recommend decompressive surgery, when appropriate, since if the decompressive surgery doesn't work, usually you're not worse off. If the fusion is causing pain, it can be quite difficult to have the hardware removed.



cage fusion