Wednesday, April 17, 2024

Spinal Surgery With Rods And Screws

How Should I Prepare For Instrumented Spinal Fusion

lower back surgery 3 levels of spinal fusion with rods and screws vlog 105

This procedure is performed under general anesthesia, which means the patient is unconscious and can not feel pain during the procedure.

In certain cases, before performing the spinal fusion the surgeon decompresses the spinal cord or nerve roots to alleviate pain and remove damaged tissue. In patients with deformities such as scoliosis or kyphosis, our surgeons may remove a portion of the spinal column to loosen or release the deformity, allowing the spine to be realigned.

Spinal fusion may be performed at any level of the spine: cervical, thoracic, lumbar, or sacral. In some patients with weakness or instability at the very highest level of the spine, the fusion may extend to the base of the skull, a so-called occipito-cervical fusion. In the lower part of the spine, the fusion may also be extended to the pelvis, a so-called spino-pelvic fusion.

Posterior fusions, or fusions from the back of the spine, often use instruments called pedicle screws. These are specialized bone screws that are implanted into the pedicles, thick, sturdy sections of bone at the back of the spine. Pedicle screws do not provide stability themselves but provide attachment points for the rods, inserted next, that form the span of the metal bridge.

Using A Tubular Retractor

This technique involves progressive dilation of the soft tissues, as opposed to cutting directly through the muscles. By using tubes to keep the muscles out of the way, the surgeon works through the incision without having to expose the area widely. Sometimes, the surgeon will also utilize an endoscope or microscope focused down the tube to assist with performing the surgery through a minimal access strategy. Once the procedure is complete, the tubular retractor can be removed, allowing the dilated tissues to come back together. Depending on the extent and type of surgery necessary, incisions can often be small.

Percutaneous Placement of Screws and Rods

Depending on the condition of the patient, it may be necessary to place instrumentation, such as rods and screws, to stabilize the spine or to immobilize the spine to facilitate fusion of the spinal bones. Traditional approaches for placement of screws requires extensive removal of muscle and other tissues from the surface of the spine.

Direct Lateral Access Routes

In some cases, especially those involving the lumbar spine, approaching the spine from the side of the body results in reduced pain, due to the limited amount of muscle tissue blocking the way. This approach is typically performed with the patient on his or her side. Then, a tubular retractor docks on the side of the spine to enable access to the spines discs and bones.

Thoracoscopic Access Route

Dr Maroon The Athlete

Dr. Maroon received an athletic scholarship to Indiana University in Bloomington, Indiana where as an undergraduate, he was named a Scholastic All-American in football. Dr. Maroon has successfully maintained his personal athletic interests through participation in 9 marathons and more than 72 Olympic-distance triathlon events. However, his greatest athletic accomplishment is his participation in 8 Ironman triathlons , where he usually finishes in the top 10 of his age group. Recently, in July 2012 and 2013, he finished second and third, respectively, in his age group in the Muncie, Indiana half Ironman triathlon. In October 2013 he completed his 5th World Championship Ironman in Kona, Hawaii.

As a result of his athletic dedication and performance, Dr. Maroon was inducted into the Lou Holtz Upper Ohio Valley Hall of Fame for his athletic accomplishments and contributions to sports medicine on June 27, 1999. Eleven years later, on March 14, 2010 he was inducted into the National Fitness Hall of Fame in Chicago. Other inductees include Gov. Arnold Schwarzenegger Jack LaLanne and Kenneth Cooper, founder of the Aerobic Movement.

For all his accomplishments, Dr. Maroon was in 2011 selected as a Distinguished Alumnus of Indiana Universityone of 5 selected annually from 500,000 alumni from the university.

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Degenerative Spine Disease Without Instability

A great deal of controversy remains regarding the application of fusion surgery in the treatment of degenerative spine disease without overt instability. In the future, these controversies will be addressed by a two-pronged approach. First, rigorous randomized controlled trials are needed to better assess the efficacy of existing methods of fusion. Second, novel treatment strategies are needed to replace fusion surgery.

Disk arthroplasty and posterior dynamic stabilization devices are two strategies that are under investigation. Some brands of artificial disk for treatment of symptomatic lumbar degenerative disk disease have been approved by the US Food and Drug Administration . Short-term studies revealed equivalent results for disk arthroplasty and lumbar fusion.

A prospective, randomized, controlled multicenter study designed to show the “noninferiority” of cervical total disk replacement revealed that this technology was at least equivalent to anterior cervical diskectomy and fusion with regard to outcome at 24 months. Although most primary outcome measures were equivalent in the two groups, the disk replacement group showed a lower requirement for analgesics and lower reoperation rate than the fusion group at 24 months.

In the long-term future, biologic rather than mechanical treatment strategies directed at repairing and maintaining the degenerated spine elements are more likely to provide a satisfactory solution to the problem of degenerative spine disease.

Posterior Spinal Fusion With Instrumentation

intaroperative and posteporative views of scoliosis surgery. â Steemkr

Performed to stop curvature of the spine and achieve permanent correction. The procedure provides permanent stabilization in the corrected position by removing the joints between the vertebrae to be fused.

  • All the vertebrae involved in the curve are prepared and bone graft is placed in each space resulting from joint removal.
  • Over time , the graft adheres to the vertebral bone, and the operated portion of the spine heals into a solid block of bone which cannot bend, thus eliminating further progression of the curve.
  • Typically, in a child who has reached an appropriate age for definitive fusion, instrumentation will also be placed when the fusion is performed. The instrumentation rigidly fixes the spine internally through rods being attached to screws, hooks and wires at multiple sites along the curve so that the corrected position is carefully preserved while the fusion is completed over a 4- to 6-month period.
  • Depending on the flexibility of the curve and any preceding treatment , there may even be additional correction of the curve achieved by the application of the instrumentation.
  • Often the patient does not need a cast or brace if the internal instrumentation is felt to be adequate at the time of surgery.

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Back Surgery Pros And Cons

Each type comes with its own risks and benefits.

Spinal fusion. This is the most common surgery for chronic nonspecific back pain with degenerative changes. The doctor will join spinal bones, called vertebrae, together. This limits the motion between them and how far your nerves can stretch. But it probably wonât limit your activity. Itâs rare, but the bones donât always fuse completely. Smoking can make this complication more likely. If it happens, you may need another operation to fix it.

Laminectomy. This is the most common surgery for lumbar spinal stenosis. In this procedure, a surgeon removes parts of the bone, bone spurs, or ligaments in your back. This relieves pressure on spinal nerves and can ease pain or weakness, but the procedure can make your spine less stable. If that happens, youâll probably need a spinal fusion as well. Doctors sometimes do the two procedures together.

Foraminotomy. This surgery is used to relieve pain associated with a compressed nerve in the spine. The surgeon cuts away bone at the sides of your vertebrae to widen the space where nerves exit your spine. The extra room may relieve pressure on the nerves and ease your pain. Like a laminectomy, this procedure can also make your spine less stable. So the surgeon may do a spinal fusion at the same time. Thatâll increase the amount of time you need for recovery.

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Uses Of Spinal Fusion

Spinal fusion is performed to treat or relieve symptoms of many spinal problems. The procedure removes mobility between the two treated vertebrae. This may decrease flexibility, but its useful for treating spinal disorders that make movement painful. These disorders include:

  • fractured vertebrae that may be making your spinal column unstable
  • spinal weakness or instability due to severe arthritis, tumors, or infections
  • spondylolisthesis

A spinal fusion procedure may also include a discectomy. When performed alone, a discectomy involves removing a disc due to damage or disease. When the disc is removed, bone grafts are placed into the empty disc space to maintain the right height between bones. Your doctor uses the two vertebrae on either side of the removed disc to form a bridge across the bone grafts to promote long-term stability.

When spinal fusion is performed in the cervical spine along with a discectomy, its called cervical fusion. Instead of removing a vertebra, the surgeon removes discs or bone spurs from the cervical spine, which is in the neck. There are seven vertebrae separated by intervertebral discs in the cervical spine.

Typically, the preparation for spinal fusion is like other surgical procedures. It requires preoperative laboratory testing.

Before spinal fusion, you should tell your physician about any of the following:

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How Does Spinal Fusion Work

With several approaches to spinal fusion, your physician can determine the one that best suits your individual needs.

Not everybody with low back pain will require surgery. But if your condition is one that requires surgery, rest assured that spinal fusion has a long history as a treatment option.

A spinal fusion is the permanent joining of two or more vertebrae so that there is no movement between them. Over time they heal into a single, solid bone. The procedure involves roughening the bone between two adjacent vertebrae and then placing bone graft between them. In some cases, disc material may be replaced with autogenous bone graft and/or allograft material, or in the case of degenerative disc disease with or without Grade 1 spondylolisthesis, plastic or metal spacers may be used instead. Rods and screws are then placed to create an “internal cast” that support the vertebrae, holding it together until the fusion, or bony regrowth, can occur.

What Are The Risks Of Spinal Fusion

Screws, Rods and Plates in my Spine: Oh My!

Potential risks to any surgical procedure include unforeseeable complications caused by anesthesia, blood clots, undiagnosed medical problems such as silent heart disease, and rare allergic reactions. Complications of spinal surgery can include neurological damage, damage to the surrounding soft tissue and, where used, instrument malfunction. Most of these complications can be treated once they are detected, but sometimes they require a longer period of hospitalization or recovery, additional medications, and sometimes even additional surgery. Depending upon the type of surgery you are having, these risks will be explained by the primary surgeon. Other risks associated with implants used include device migration, loss of spinal curvature, correction, height, and/or reduction. As a patient, it is important to understand and follow your doctors advice so that the best possible outcome can be achieved. Surgery is not for everyone. Please consult your physician.

Information on this site should not be used as a substitute for talking with your doctor. Always talk with your doctor about diagnosis and treatment information.

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Common Mis Surgery Treatment Options

A number of specific techniques have been deployed for MIS surgery. Though the field continues to develop, the list below highlights some of the most common options.

Discectomy: Spinal discs are essentially elastic rings with soft material inside that serve as cushions between the vertebral bones. If the elastic ring becomes weakened, the soft tissue inside can extrude or herniate outside of the elastic ring. The herniated disc material can compress the nerves passing by, thus causing pain. If surgical treatment is recommended to trim or remove the herniated disc, it may be possible to perform this procedure with MIS surgery using tubular dilators and a microscope or endoscope.

Spinal decompression:Spinal stenosis, which is a narrowing of the vertebral canal, is a common condition that can result in compression of the nerves. This can produce a variety of symptoms, including pain, numbness and muscle weakness. If surgery is recommended, it may be possible to remove the bone and soft tissues causing the nerve compression through an MIS approach using tubular dilators and a microscope or endoscope. The more common decompressive procedures include laminectomy and foraminotomy.

Minimally Invasive Pedicle Screw Instrumentation

The spine is made up of small bony segments called vertebrae. Vertebrae are categorized into cervical or neck vertebrae, thoracic , lumbar and sacrum. This stack of bones is protected by the cushioning effects of intervertebral discs. A cylindrical bundle of nerve fibers called the spinal cord passes through the entire vertebral column and branches out to the various parts of our body to provide voluntary movement and sensation.

The spine consists of lamina which forms the roof and back of the spinal canal, and the pedicle joints which joins the lamina to the vertebral body to form the vertebral arch.

Aging and trauma can damage the intervertebral discs, causing the bones to painfully rub against each other and compress the nerves that pass through them. Your doctor may recommend a spinal fusion procedure, where the diseased bones are fused and supported with screws through a minimally invasive surgery called pedicle screw instrumentation.


Minimally invasive pedicle screw instrumentation is a procedure performed along with another procedure called spinal fusion. Conditions such as degenerative disc disease, scoliosis, spondylolisthesis, spinal instability, and fractures can be treated through this procedure.

Surgical procedure.

Spinal fusion is a procedure during which your doctor fuses your diseased vertebrae together thereby preventing motion at that vertebral segment.

Post-Operative Care.

Depending on your type of surgery, you may need to wear a back brace.

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Spinal Fusion Instrumentation Removal: Pros And Cons

Though spinal fusion is one of the most common types of spine surgery, its not without risks. And, spinal instrumentation problems are among the most feared and reported complications of this type of surgery. When your surgeon discovers an issue with your spinal instrumentation, he or she may recommend removing the instrumentation or leaving it in place. Why would your doctor suggest one or the other? Ill explain why in this article.

Spinal instrumentation is any combination of rods, plates, cages, interbody spacers, wires, hooks, and screws used to stabilize the spine during the bone fusion process. Photo Source:

How Is The Surgery Performed


Spinal fusion can be done one of two ways.

  • Anterior lumbar interbody fusion: Your doctor goes in through your belly
  • Posterior fusion: Your doctor goes in from the back

After they make the incision, they move the muscles and structures to the side to see your spine. The joint or joints between the damaged or painful disks are removed.

They can use screws, rods, or pieces of bone from another part of your body to connect the disks and keep them from moving. A bone graft that comes from your body is usually taken from your hip or pelvis. Bone from another person is called a donor graft. Some doctors place a substance called bone morphogenetic protein into the spine instead. It helps to stimulate bone growth.

The surgery can take several hours.

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Pedicle Screw For Spinal Fusion

Pedicle screw instrumentation is a technology that has been used to stabilize the thoracolumbar spine and now almost exclusively utilized when securing fusion constructs, due to the intended improved fusion rates and rigidity afforded by these constructs. The pedicle is a dense stem-like structure that protrude from the posterior of a vertebra. There are two pedicles per vertebra that connect to other structures . The pedicle screw system consists of the screws and the rods. The screws themselves do not fixate the spinal segment, but provide immovable anchor points that can then be connected with a rod. The screws are placed at two or three consecutive spine segments and then a short rod is used to connect the screws. This construct can suppress the motion between the segments that are being fused.

As the pedicles in the lumbar vertebrae are thicker and thus easier to cannulate and generally have protrudes that do not include significant neural or vascular structures, pedicle screws have been applying more often in the lumbar spine. Although pedicle screws are most often used in the lumbar spine, they can be implanted in the thoracic and cervical vertebra. To determine the depth and angle for screw implantation, fluoroscopy or conventional x-ray are using by the surgeons. A receiving channel is drilled and the screw is inserted.

Visit Monib’s pedicle screws: Pedicle Screws List

What Happens After Spinal Fusion Surgery

After a fusion, most kids stay in the hospital for a couple of days. That gives them time to recover from surgery and increase their movement. By the time they go home, they’ll be able to walk around and do many day-to-day things .

Kids whose scoliosis is very severe or who have other medical conditions might need a longer hospital stay. Their care team will watch for and treat any complications .

Pain after surgery is treated with both prescription medicines, such as opioid pain medicines, and over-the-counter pain medicines, such as acetaminophen and ibuprofen. Most kids take prescription pain medicines for less than 2 weeks to help them deal with pain and muscle spasms. Over the first 12 weeks after surgery, kids can gradually reduce the amount of medicine they take for pain.

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After Removal Of Spinal Hardware

Immediately after your surgery you will be taken to the recovery area. Staff will monitor your blood pressure, heart rate and breathing. If you are in any pain be sure and tell the recovery room staff. When you are stable a nurse will take you to your room.

Once you are back in your room, our nursing team will continue to check on you to make sure you are recovering well. After youve recovered from any effects of the anaesthetic, you can have something to eat and drink. Be sure and tell us if you are in any pain.

You may have a catheter to drain your bladder. This will usually be taken out the day after your surgery.

A physiotherapist visit you to ensure you can move around on your own. Your movements will be restricted. This will mean no twisting or bending. Do not lift anything heavy or drive until released by your surgeon to do so.

To prevent blood clots you may need to wear compression stockings.

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