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Symptoms of Loose Screws After Spinal Fusion
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In spinal fusion and other spinal procedures, hardware is essential for stability. Pedicle screws are commonly used to secure the vertebrae and encourage healing. Unfortunately, screw loosening is a prevalent complication of spinal fusion, occurring in up to 60% of patients.
Read on to learn more about loose screws after spinal fusion and how to reduce your risk of back surgery complications.
How Are Screws Used in Spinal Fusion?
Pedicle screws are often used in spinal fusion to support and stabilize the vertebrae as they heal. Typically, the screws are positioned above and below the fused vertebrae, and a rod links the screws to prevent motion. This helps the vertebrae and bone graft fuse properly.
These screws are called pedicle screws because they’re secured through the pedicles at the back of the vertebrae. The pedicles are cylindrical stubs of hard bone that bridge the vertebral body to the lamina.
What Causes Loose Screws?
Poor bone quality most often causes loose screws after surgery. When the bone tissue isn’t strong and dense enough to support surgical hardware, the screws may gradually loosen and trigger symptoms of failed back surgery syndrome.
Osteoporosis is a common cause of diminished bone quality and can contribute to loose screws after surgery. This bone disease occurs when bone mass and mineral density dwindles, leading to weaker, thinner bones.
What Causes Screws to Loosen After Spinal Fusion?
The possible causes of screws loosening after spinal fusion include poor bone quality, poor healing, improper screw fixation, and excessive impact on the screws.
Excessive Impact on Pedicle Screws
Excess impact on the screws after spinal fusion can result from high-impact physical activity, poor posture, and a sedentary lifestyle. Patients who frequently partake in high-impact activities (like heavy lifting) or activities that involve intensely bending or twisting the spine may experience fusion hardware failure as a result. Your surgeon will advise you on the activities to avoid after the fusion procedure.
Poor Healing
Poor healing or failed fusion can cause the pedicle screws and other hardware to loosen. Failed fusion occurs when the bone graft doesn’t successfully merge the vertebrae into a single bone.
Certain factors can increase your risk of pedicle screw loosening after spinal fusion, including:
- Diabetes: Pedicle screw loosening is more common in patients with diabetes.
- Older age: The older a patient is, the higher the risk of pedicle screw loosening.
- Low bone density: Patients with low bone density (whether due to fracture, osteoporosis, rheumatoid arthritis, or other medical conditions) are at an increased risk of loosening screws after spinal fusion.
Screws can also simply loosen after spinal fusion with time. Over the years, the screws undergo normal wear and tear, which can lead to loosening or damage. Older patients may pass naturally before experiencing the effects of wear and tear on the screws, but younger patients will likely develop symptoms at some point.
What Happens When Spinal Fusion Screws Loosen?
When spinal fusion screws loosen, they can irritate the neighboring nerves and tissue. This can cause pain, neurological symptoms, and crepitus (a grating noise or sensation).
New or recurrent back pain after spinal fusion as a result of pedicle screw loosening can indicate failed spinal fusion (also known as failed back surgery syndrome). Many patients who develop this syndrome after undergoing spinal fusion require re-operation for pain management.
Symptoms of failed spinal fusion include:
- Limited spinal mobility
- Spasms in the back
- Insomnia
- Numbness, tingling, or weakness in the extremities
- Persistent back pain
Can Failed Spinal Fusion Be Fixed?
Failed spinal fusion can often be fixed with revision surgery. Before the operation, your spinal surgeon can evaluate what went wrong and consider other surgical methods to address your symptoms, including alternatives to spinal fusion.
Patients who don’t want to undergo another surgery, or who can’t due to an underlying medical condition, can try non-surgical treatment methods. Epidural steroid injections, physical therapy, and radiofrequency ablation, among other techniques, are non-surgical options for failed spinal fusion.
Spinal Fusion Alternatives
Spinal fusion alternatives include dynamic stabilization systems, IDET, and stem cell therapy. These advanced treatments promote healing without limiting the motion of the spine.
Stem Cell Therapy
Stem cell therapy is rapidly gaining traction as a non-surgical treatment option for musculoskeletal conditions. With the potential to regenerate damaged tissue, stem cell therapy may offer benefits for degenerative spinal conditions.
During stem cell therapy, stem cells derived from the patient’s blood or a donor are administered directly into the damaged area via injection. Stem cells have the unique ability to self-renew and develop into just about any specialized cell. As a result, stem cells can gradually repair injured tissue in the spine, leading to lasting pain relief in some patients.
Given that stem cell therapy for back pain is a relatively new treatment option, research is still in its early stages. Not all patients have access to an experienced stem cell specialist in their area. However, the initial experiences with rats have produced positive results, indicating that stem cells may help heal damaged intervertebral discs.
Intradiscal Electrothermal Coagulation (IDET)
IDET involves inserting a needle into the affected disc area. The physician then threads a catheter through the needle and applies gentle heat to the exterior of the intervertebral disc. This process helps strengthen and thicken the collagen fibers in the disc exterior, potentially offering relief from chronic back pain.
Dynamic Stabilization Systems
Dynamic stabilization systems can replace spinal fusion after spinal decompression surgery. This type of surgical implant stabilizes the spine without permanently limiting its motion. One dynamic stabilization system is the TOPS System for the L3 to L5 vertebrae.
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The TOPS System offers immediate pain relief with the ability to move the spine in all directions. It also reduces the stress on adjacent spinal levels when compared to spinal fusion. As an alternative to lumbar spinal fusion for spinal stenosis and spondylolisthesis, the TOPS System provides motion preservation, ideal decompression, and stability.
Spinal fusion alternatives like the TOPS System may help you avoid re-operation after back surgery. Schedule an appointment with a spine specialist in your area to learn more.
Spinal Fusion Surgery
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Back pain from degenerative spinal conditions can be debilitating and disruptive to your normal activities. In some patients, back pain causes their quality of life to decline, making effective treatment options all the more crucial.
If you’ve been suffering from chronic back pain for several months, surgery may be on the table. Spinal fusion is one form of back surgery that’s commonly used for disorders like spinal stenosis, spondylolisthesis, and herniated disc. It’s widely performed with spinal decompression procedures to restore stability in the spine.
In some patients, spinal fusion alleviates their back pain and allows them to live a happier, more comfortable life. However, as an invasive surgical procedure, spinal fusion is associated with various risks and complications. In this article, we’ll provide a complete overview of spinal fusion and discuss modern fusion alternatives that back pain patients can now consider.
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Am I a Candidate For Spinal Fusion?
You may be a candidate for spinal fusion if you have chronic, severe back pain that hasn’t responded to several months of non-surgical treatment. Additionally, candidates for spinal fusion often have limited mobility due to back pain and neurological symptoms.
Candidates for spinal fusion may have one of the following spinal conditions:
- Spinal fusion
- Spondylolisthesis
- Degenerative disc disease
- Herniated disc
- Vertebral fracture
- Scoliosis
- Spinal tumor
Some patients are not considered candidates for spinal fusion due to a severe, underlying medical condition, or an infection. Additionally, patients with a disease that impacts multiple spinal levels may be advised against spinal fusion surgery due to the higher risk of lost mobility.
What Are The Steps of Spinal Fusion?
The steps of spinal fusion include accessing the spine through an incision, preparing the bone graft, securing the bone graft between the vertebrae, and closing the incision. These general steps can vary depending on the surgical approach.
Additionally, keep in mind that spinal decompression surgery, such as laminectomy, is often performed immediately before the fusion.
Surgical Approaches to Spinal Fusion
The primary approaches to spinal fusions that surgeons use today include:
- PLIF, or posterior lumbar interbody fusion
- ALIF, or anterior lumbar interbody fusion
- TLIF, or transforaminal lumbar interbody fusion
- XLIF, or extreme lateral interbody fusion
The Steps of PLIF
PLIF involves accessing the spine posteriorly, or through the back. During this procedure, the surgeon will complete the following steps:
- First, the surgeon creates an incision in the back over the vertebrae to be fused. The back muscles must be moved aside to expose the spine.
- If applicable, spinal decompression is performed at this stage. This often involves removing part of the lamina, which covers the back of the vertebra.
- Once the decompression has been completed, damaged disc tissue is removed. The bone graft is placed in the disc space between the affected vertebrae. The graft is usually held in place with an implant, such as a spinal cage or interbody spacer.
- The back muscles are returned to their normal positions and the incision is closed.
The Steps of ALIF
ALIF uses an anterior, or frontal, approach with the following steps:
- To start, the surgeon creates an incision in the lower portion of the abdomen and moves aside fat and muscle tissue to access the peritoneum. The peritoneum is a sack that contains the abdominal organs.
- Once the surgeon gains access to the peritoneum, they move it to the side to reach the spine without going through the abdomen. Large blood vessels are located over the front of the spine and must also be moved aside to perform the fusion.
- Decompression surgery may be performed at this stage.
- After removing the disc material, the surgeon positions the bone graft in the disc space with the help of an implant.
The Steps of TLIF
Transforaminal lumbar interbody fusion is completed through the foramina, which are the bony openings located between adjacent vertebrae. This approach to spinal fusion may be suggested if the patient has spinal degeneration that’s mainly on one side of the spine.
- For TLIF, the surgeon creates an incision along the spine, directly above the affected vertebra. Similar to PLIF, the surgeon must move the back muscles aside to reach the spine.
- The surgeon can now access the disc space by drilling from one side of the spine, then extracting the lamina and/or facet joint.
- At this point, the damaged intervertebral disc material is removed and the bone graft is positioned in its place, secured by a fusion implant.
- The back muscles are repositioned and the incision is closed with sutures.
The Steps of XLIF
XLIF is a minimally-invasive approach to spinal fusion. This is a relatively new surgical method that eliminates the need to create an incision in the abdomen or cut the large muscles of the back.
- First, the surgeon makes an incision in the flank, which is the lower back area of the abdomen. The peritoneum must then be moved away from the abdominal wall.
- Next, a dilator is placed into the peritoneum and moved toward the affected disc. The surgeon takes fluoroscopy images to confirm that the dilator is in the optimal position.
- To prevent nerve interference, a probe is placed through the psoas.
- At this stage, the surgeon removes the damaged disc and puts bone graft material in its place, through the incision in the flank.
- The peritoneum is returned to its usual position and the incision is closed with sutures.
How Long Does Spinal Fusion Take?
Spinal fusion surgery takes between four and seven hours, in most cases. The more complex the procedure, the longer the surgery will take to complete.
After fusion surgery, you can expect to stay in the hospital for two to seven days. If you undergo a minimally-invasive form of the procedure, you’ll likely be released from the hospital sooner. During your hospital stay, you may be given prescription pain medication through an IV to manage discomfort from the procedure. Additionally, if you have pain around the incision, you may be given a soft brace.
While you’re in the hospital, you’ll probably start to work with a physical therapist to complete basic activities, including sitting up in bed, standing up, walking without bending the spine, and getting dressed. Your therapist can also advise you on how to safely care for your incision.
What is The Average Recovery Time for a Spinal Fusion?
The average recovery time for a spinal fusion is six months to a year. This is the amount of time required for the spine to heal completely.
Spinal Fusion Recovery
Spinal fusion recovery is a relatively long process involving several stages. Your surgeon will help guide you through these stages, advising you on the activities that you can resume – and those that you should continue to avoid.
Here’s a general timeline of the spinal fusion recovery process:
1 to 4 Weeks
During this phase of your recovery, your activities will be relatively limited. You may still need help to complete light housework, and you’ll likely still need medication for pain management.
However, if you have a sedentary job, you may be able to return to work within a few weeks of the procedure. You’ll need to avoid bending or twisting the spine, lifting anything other than light objects, and driving.
1 to 3 Months
One to three months after spinal fusion, you’ll start to complete basic chores around the house. Your doctor may also clear you to drive during this stage. However, you still won’t be able to bend, twist, or lift heavy objects.
During this phase, you’ll be attending physical therapy to ensure that the spine heals properly. A physical therapist will help you regain strength and mobility without jeopardizing the fusion process.
3 to 6 Months
During this stage of spinal fusion recovery, you can gradually return to cardiovascular exercise and stretching. While you won’t be able to bend the spine or lift heavy objects, your activities won’t be as restricted.
6 Months to 1 Year
During this period, your surgeon can determine if the fusion was successful. If the vertebrae fused properly and the spine appears healthy, you can return to most of your usual activities, including bending and twisting the spine. Keep in mind that some mobility is lost to the fusion process, so your spinal mobility will still be somewhat limited.
Beyond the 1-year mark, your vertebrae may continue to heal, along with any damaged nerves. In some cases, spinal nerve damage takes two years to heal completely. However, most patients are virtually pain-free after a year of recovering from spinal fusion.
What Are The Risks and Complications of Spinal Fusion?
The risks and complications of spinal fusion include limited mobility, pseudoarthrosis, adjacent segment disease, recurrent pain, and muscle atrophy. These risks are in addition to those of all surgical procedures, such as infection, blood clots, and adverse reactions to anesthesia.
Limited Mobility
Limited mobility can occur after spinal fusion due to lost mobility at the fused segment. Once the vertebrae have fused into a single bone, the patient loses the ability to bend or twist at that segment. In some cases, patients require a reacher tool to retrieve items on the floor after spinal fusion.
Lost mobility is particularly common after multi-level fusions. However, even for patients undergoing a single-level fusion, it’s crucial to talk to your surgeon about how lost spinal mobility could impact your lifestyle.
Pseudoarthrosis
Pseudoarthrosis, or failed fusion, occurs when the vertebrae fail to fuse after the surgery. Unfortunately, pseudoarthrosis continues to be a risk with modern fusion methods. This complication typically creates the need for additional surgery.
According to a clinical review published in 2022, rates of pseudoarthrosis range greatly from 0% to 20% to greater than 60%, depending on which study you reference. A 2015 study noted that at least 15% of patients who undergo primary lumbar fusion experience pseudoarthrosis.
While the exact rate of pseudoarthrosis is unclear, it’s a distinct risk, particularly for patients who smoke, use steroids or have diabetes.
Adjacent Segment Disease
Adjacent segment disease, or ASD, is a possible complication of spinal fusion. It develops when the spinal segments above and below the fused segment degenerate more rapidly than usual. This occurs because the adjacent segments must compensate for the lost motion at the fused segment.
As the adjacent segments start to degenerate, patients may experience back pain and/or neurological symptoms, such as tingling, weakness, and numbness. Eventually, some patients with ASD require reoperation to resolve their symptoms.
ASD is estimated to impact 11 to 12% of patients 5 years postoperatively and 16 to 38% at the 10-year mark.
Recurrent Pain
In some cases, spinal fusion surgery doesn’t resolve the patient’s back pain. This may occur in up to 40% of patients.
Muscle Atrophy
Muscle atrophy is the term used for muscle tissue that thins out or wastes away. Since spinal fusion limits how much patients can use their back muscles, it can lead to muscle atrophy. When the muscle tissue around the spine atrophies, it reduces support for the spine and increases the risk of future injury.
Surgical Risks
All surgical procedures come with certain risks, including:
- Hemorrhage
- Shock
- Deep vein thrombosis
- Pulmonary embolism
- Infection
- Allergic reactions to anesthesia
Alternative to Lumbar Spinal Fusion
Given the risks and complications of spinal fusion, many patients look for alternative treatment options. Thankfully, the latest advancements in medical technology have paved the way for fusion alternatives, including the TOPS System.
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The TOPS System is a non-fusion implant that stabilizes the spine without permanently fusing the vertebrae or compromising the patient’s range of motion. It moves with the spine, preventing lost mobility, adjacent segment disease, and related complications.
Talk to a spine specialist in your area to learn more about alternatives to fusion for chronic spinal conditions.
Permanent Restrictions After Spinal Fusion
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Spinal fusion is frequently performed for conditions like spinal stenosis, spondylolisthesis, and spinal deformities. This surgical procedure effectively welds two or more vertebrae to create stability.
Though fusion has proven to be successful in many cases, it also presents numerous risks and downsides. In this article, we’ll hone in on the permanent restrictions that patients may be subject to after spinal fusion.
What To Expect After Spinal Fusion?
Many patients wonder about the spinal fusion recovery process, especially at the six-month mark. Fusion involves bone healing, which leads to a notoriously lengthy recovery. Three months of rest is crucial after the surgery to allow the vertebrae to properly fuse.
However, three to six months after the procedure, patients can begin to introduce certain activities into their routines. Patients will likely experience a loss in muscle tone, strength, and flexibility during the resting period. These effects can be offset by gentle exercises to alleviate stiffness and gradually strengthen the muscles that support the spine.
Six months after spinal fusion, physicians typically still advise against high-impact exercise. However, if the vertebrae are successfully fused, patients can slowly start to return to a regular lifestyle.
Most patients fully recover from spinal fusion around eight to 12 months after the procedure. At this point, patients may be able to partake in all of their normal activities.
However, spinal fusion patients will never regain the ability to bend, twist, or flex the fused segment. This is because spinal fusion eradicates all motion at the fused segment.
How Many Years Does a Spinal Fusion Last?
If a spinal fusion is successful, it permanently fuses the affected vertebrae. Ideally, the patient won’t require another procedure.
Unfortunately, in some cases, patients require revision surgery after spinal fusion. It’s difficult for researchers to determine the exact revision rate for adult spinal fusion surgeries. However, it’s estimated to range from 9% to 45%.
What Are the Common Issues After Spinal Fusion Procedure?
Certain problems that can arise after spinal fusion must be resolved with revision surgery. These problems include:
- Pseudoarthrosis
Pseudoarthrosis is the medical term used when the bone graft fails to fuse the vertebrae after spinal fusion. This condition may cause lower back pain, but requires imaging tests for diagnosis.
- Recurrent back pain after the procedure
Spinal fusion surgery doesn’t always eradicate lower back pain. Many people who experience recurrent back pain after fusion go through additional surgeries within five years of the initial procedure.
- Adjacent segment disease
Adjacent segment disease, or ASD, is a prevalent complication after spinal fusion. It involves the degeneration of the spinal segments neighboring the fused vertebrae. This occurs because the adjacent segments must bear additional impact than usual to accommodate the lack of motion in the fused segment.
ASD can cause new pain in the area of the back located above or below the fused segment. Eventually, patients may have trouble standing or walking for any length of time.
- Neurological symptoms like tingling, weakness, numbness, and radiating pain
Whether due to pseudoarthrosis, ASD, or a related issue, neurological symptoms stemming from the lumbar spine can disrupt patients’ daily activities.
- Muscle atrophy
Muscle atrophy can affect the back muscles in the area of spinal fusion. This issue commonly affects patients who experience continued pain after spinal fusion. Unfortunately, muscle atrophy can diminish support for the spine and may increase the risk of pseudoarthrosis.
Lost Mobility After Spinal Fusion
In addition to the medical concerns listed above, spinal fusion can lead to lost mobility in the spine. This can greatly affect patients’ lifestyles by limiting their physical activities and even their ability to carry out basic tasks. In some multi-level fusion cases, patients lose the ability to bend over to retrieve objects from the floor after the surgery.
The L4 and L5 vertebrae, which are the lowest bones of the lumbar spine, often afford the most motion for the lower back. These vertebrae may be fused in patients suffering from conditions like advanced lumbar spinal stenosis and spondylolisthesis. After an L4-L5 fusion, patients may experience a significant loss of motion in the lower back.
How To Avoid Spinal Fusion?
Considering the complications and restrictions that are associated with spinal fusion, many patients seek out ways to avoid this procedure. In these cases, patients may either opt for non-surgical treatment options or surgical spinal fusion alternatives.
Non-Surgical Spinal Fusion Alternatives
Patients suffering from chronic back pain and neurological symptoms from conditions like spinal stenosis and herniated disc often benefit from conservative treatment. In fact, spine specialists generally first recommend conservative treatment, only suggesting surgery if the non-surgical treatment route fails after several months.
Conservative treatments that may help patients avoid spinal fusion include:
- Physical therapy
- Lifestyle adjustments, such as losing weight, starting a low-impact exercise regimen, adopting an anti-inflammatory diet, and refraining from high-impact activities
- Chiropractic care
- Acupuncture and massage therapy
These therapies can help reduce the impact on the spine, improve muscular support for the spine, reduce inflammation, and promote healing. Most physicians recommend a combination of non-surgical treatments for chronic back pain.
Surgical Spinal Fusion Alternatives
When spinal pain becomes debilitating and/or severely interferes with the patient’s daily activities, surgery may be unavoidable. But, with modern medical advancements, patients now have non-fusion surgical treatment options to consider.
Dynamic stabilization systems are among the most prominent of these options. The goal of this treatment is to stabilize the spine without inhibiting its motion, usually with a specially-designed device. This device is generally placed in the affected segment after surgical spinal decompression.
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The TOPS System is one example of a dynamic stabilization system that’s used as an alternative to lumbar spinal fusion. It replaces the tissues removed in spinal decompression to prevent spinal stability while restoring the natural motion of the spine.
Patients who are concerned about permanent restrictions after spinal fusion should reach out to a spine specialist to learn more about the fusion alternatives available today.
Laminectomy with Fusion
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When spinal conditions don’t improve despite ongoing non-surgical treatment, surgery may be the logical next step. Laminectomy with fusion is one of the most prominent spinal decompression procedures for conditions like spinal stenosis, spondylolisthesis, and herniated disc.
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But, what exactly does laminectomy with fusion involve, and is it the right choice for you? Read on to learn more about this topic and how it may impact your spinal recovery.
What is Laminectomy with Fusion?
Laminectomy is a form of spinal decompression that’s commonly done with fusion to stabilize the spine. During a laminectomy, the surgeon removes the smallest quantity of the lamina possible while effectively resolving the nerve compression.
The lamina is a piece of bone that forms part of the vertebral arch. It acts like a roof over the posterior side of the spinal canal.
Conventionally, spinal fusion is performed after a laminectomy (and most other forms of spinal decompression). During spinal fusion, the surgeon places an implant containing bone graft material between the vertebrae. Over time, this graft stimulates bone tissue fusion, creating a single vertebra.
Fusion after laminectomy effectively lowers the risk of injuries due to spinal instability. However, it also eliminates all motion at the fused segment, which may permanently limit the patient’s mobility.
How Successful Is a Laminectomy With Fusion?
Laminectomy with fusion is widely considered a successful procedure for disorders like spinal stenosis and spondylolisthesis. A study published in The New England Journal of Medicine concluded that lumbar laminectomy with spinal fusion provided a slightly greater improvement in overall physical health when compared to laminectomy alone. This study included 66 patients with degenerative grade 1 spondylolisthesis.
However, laminectomy alone is considered safer than spinal fusion. According to Dr. Steven Atlas, an associate professor of medicine at Harvard Medical School, laminectomy provides 80% to 90% pain relief for spinal stenosis, without the risks associated with fusion.
Do You Need Fusion with Laminectomy?
You may need fusion with laminectomy if a part of the spine is unstable after laminectomy. Spinal instability creates the risk of further injury.
However, innovations in spinal medicine have produced alternatives to fusion for stability after decompressive laminectomy. We’ll discuss these innovations, including the TOPS System from Premia Spine, in a later section.
What Is the Recovery Time for a Lumbar Laminectomy With Fusion?
The recovery time for a lumbar laminectomy with fusion can last between two months and a full year. Many factors can affect this recovery period, including the patient’s age and overall health, as well as the severity of the spinal condition.
Spinal fusion extends the recovery period after a lumbar laminectomy. This is because spinal fusion involves bone tissue recovery, which is a lengthy process.
Returning to Work After a Lumbar Laminectomy with Spinal Fusion
Generally, healthy patients with non-strenuous jobs can expect to return to work following a lumbar laminectomy with spinal fusion after four to six weeks of rest. Older patients or those with strenuous jobs may need four to six months of recovery time before returning to work.
What Are The Risks of Laminectomy With Fusion?
The risks of laminectomy with fusion include those associated with all surgical procedures, including bleeding, infection, blood clots, and complications from anesthesia. Since this surgery involves the spine, it also presents a low risk of injury to the spinal cord or spinal nerve roots.
In permanently fusing two or more vertebrae of the spine, fusion creates the risk of a few other complications, including:
- Pain at the graft site
Some patients experience pain at the site of the bone graft. In 2.8% to 39% of patients, this pain has been reported to last for over three months. Graft site pain has been reported to last for up to two years in 15% to 39% of patients.
- Pseudoarthrosis
Pseudoarthrosis refers to bone fusion failure. This complication is significantly higher in patients who smoke, as nicotine hinders the bone fusion process. Unfortunately, patients who experience pseudoarthrosis will likely require extra surgeries to reliably fuse the vertebrae.
- Adjacent segment disease
Adjacent segment disease, or ASD, occurs when the spinal segments around the fused bone degenerate after fusion. The surrounding segments may undergo additional impact to compensate for the fused bone, leading to degeneration. Regrettably, ASD can lead to re-operation if it causes chronic back pain and neurological symptoms that don’t improve with non-invasive methods.
Can You Walk Normally After Laminectomy With Fusion?
You can gradually walk normally after laminectomy with fusion, typically with the help of a physical therapist. Walking is actually highly beneficial after spinal surgery, as it’s a low-impact activity that promotes circulation and mobility.
Typically, surgeons recommend that patients stand up and gently walk (with assistance) the day after laminectomy with fusion to prevent muscle stiffness and atrophy. For the first six weeks or so after the procedure, walking may be the sole physical activity that you can safely complete. Many physicians recommend working up to two 30-minute walks per day in this early recovery stage.
Non-Fusion Implants For Laminectomy
Non-fusion implants provide a solution for laminectomy without fusion. This allows patients to avoid the downsides of spinal fusion while achieving relief from chronic back pain and neurological symptoms. According to a research article published in BMC Musculoskeletal Disorders, walking time in the first week after lumbar spine surgery is one of the factors that predicts notable improvement at six months post-op.
There are multiple non-fusion implants available to patients today, including artificial discs, expandable rods, and complete implant systems like the TOPS System. These devices (which are also referred to as motion preservation devices) generally fall under one of three categories: total disc replacement, posterior stabilization devices, and prosthetic nuclear implants.
How Premia Spine TOPS System Cures Spondylolisthesis and Spinal Stenosis Without Fusion
The Premia Spine TOPS System cures spondylolisthesis and spinal stenosis without fusion by establishing a controlled range of motion in the spine. It’s a mechanical implant device designed to be implanted in the L2 to L5 segments of the spine with a posterior surgical approach.
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The TOPS System facilitates motion in all directions, including axial rotation, lateral bending, extension, and flexion. Unlike fusion, it replaces the vertebral structures extracted in spinal decompression, such as the lamina removed during laminectomy. It also features a patented crossbar configuration, which imparts less stress on the screws than fusion implants.
After nerve compression in spondylolisthesis and spinal stenosis patients is resolved during a laminectomy, the TOPS System can be placed to prevent instability. This technique effectively cures spondylolisthesis and spinal stenosis without fusion, with the TOPS system providing an average improvement of 81% in a clinical study published in the Operative Neurosurgery journal.
Though the TOPS System has been used successfully for many years in Europe and other regions, it’s currently being tested in clinical trials across the United States. The device was awarded the FDA’s Breakthrough Device Designation in 2021, which will prioritize its process of obtaining FDA approval.
If you’re interested in the TOPS System as an alternative to laminectomy with fusion, find a doctor in your area to learn more about this treatment option.
10 Years After Spinal Fusion: Studies and Research
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Spinal fusion has been used for several decades to treat spinal conditions like scoliosis, spondylolisthesis, and spinal stenosis. Considering its expansive history, we can evaluate the long-term outcomes of spinal fusion
While spinal fusion is largely considered a successful treatment for long-term results, patients have recurring pain after the procedure. As long as 10 years after the procedure, problems including adjacent segment degeneration and hardware damage can cause symptoms to reappear.
This article will explore the studies and research relating to the longevity of spinal fusion, as well as available treatment alternatives to consider.
How Many Years Does a Spinal Fusion Last?
Spinal fusion is intended to last for life, as the results are permanent. Many spinal fusion patients experience improved pain and mobility for many years after the surgery.
However, the hardware used in spinal fusion can break down over time, creating the need for reoperation. Additionally, recurring back pain is a common problem among spinal fusion patients.
Is Spinal Fusion a Disability?
Spinal fusion may be considered a disability if the patient meets certain qualifications, including specific mobility restrictions. Qualifying spinal fusion patients can receive Social Security benefits.
To receive disability benefits after undergoing lumbar spinal fusion, patients must have been diagnosed with a disorder of the spine, such as:
- Spinal stenosis
- Spondylolisthesis
- Degenerative disc disease
- Vertebral fracture
- Osteoarthritis
- Any other spinal disorder that affects the spinal cord or nerve root
Restrictions after the spinal fusion procedure can make it difficult to work. Disability benefits can help patients maintain their quality of life while they heal from spinal fusion.
Will I Have Restricted Mobility After Spinal Fusion?
You will have some degree of restricted mobility after spinal fusion. This is because the goal of spinal fusion is to eliminate motion between the affected vertebrae. With this process comes permanently restricted spinal mobility.
For most patients who undergo a single-level spinal fusion, mobility restrictions aren’t dramatically life-altering. Once the spine has fully healed, these patients can often partake in their normal activities, though spinal bending, rotations, and stretches may be marginally limited.
Patients who have multiple spinal levels fused are likely to experience significant mobility restrictions. In some cases, patients may not be able to bend over as they once could and may need a device to retrieve dropped or fallen objects.
Pain 10 Years After Spinal Fusion
Pain 10 years after spinal fusion is relatively common, with up to 40% of patients experiencing continued pain after back surgery. Over 10 years, the fused vertebrae or fusion hardware can develop various issues that lead to pain.
Studies: Recurrent Pain After Spinal Fusion
Multiple studies have evaluated the long-term effects of spinal fusion. Here are a few to consider:
- A 2020 prospective 10-year follow-up assessment for spinal fusions reported a 7.5% chance of revision surgery 10 years after the procedure. Patients reported quality of life at the 10-year mark that’s only slightly lower than healthy peers and notably higher than scoliosis patients who didn’t undergo spinal surgery.
- A 2003 study evaluated pain five years after lumbar spinal fusion. It found that there was a high incidence of pain five years after posterolateral spinal fusion surgery, although the patients experienced significant general improvement over the five-year period. This study concluded that lumbar spinal fusion may be considered a pain-reducing procedure, rather than a pain-removing procedure.
- A 2018 study evaluated the long-term outcome of posterior spinal fusion for correcting idiopathic scoliosis in teens. This study found that while the procedure is safe and effective, it can result in permanent complications like degenerative disc disease. Researchers concluded that physicians should discuss the risk of post-operative disability with patients considering spinal fusion surgery.
- A 2017 study found that lumbar fusion surgery for degenerative conditions was associated with long-term pain and psychotropic medication use. According to this study, 62.5% of the participants continued to chronically use narcotics after spinal fusion. 95% of patients who had been taking narcotics before the procedures continued to take them two years after fusion.
What Can Cause Recurrent Pain After Spinal Fusion?
The most common causes of recurrent pain after spinal fusion include:
- Fusion Failure (Pseudoarthrosis)
When the vertebrae fail to merge into a single bone after spinal fusion, it’s known as pseudoarthrosis. While some patients who develop this condition don’t experience symptoms, it typically causes recurring pain and neurological symptoms. Another spinal fusion procedure is the typical treatment for pseudoarthrosis.
One study reported that pseudoarthrosis occurs in at least 15% of primary lumbar fusions. Though this complication is typically associated with lower back pain or radicular pain, it can be asymptomatic.
- Hardware Failure
As we mentioned in a previous section, the hardware used in spinal fusion surgery is highly durable, but doesn’t last forever. Some patients with recurring pain 10 years after spinal fusion may be experiencing the effects of hardware failure.
Pedicle screws, rods, spacers, and cages are all types of hardware commonly used in spinal fusion. This hardware can degenerate or even break over time, especially if the spine is subject to significant stress and impact. Worn-out or broken hardware can lead to recurrent spinal pain, along with neurological symptoms.
- Adjacent Segment Disease (ASD)
Adjacent segment disease is a possible complication of spinal fusion. It develops when the vertebrae surrounding the fused segment endure the brunt of the impact from day-to-day motions. This occurs because the adjacent vertebrae must compensate for the lost mobility in the fused segment.
According to a clinical review published in Clinical Spine Surgery, between 2% to 4% of spinal fusion patients per year experience adjacent segment disease. It leads to symptoms including:
- Back pain
- Pain that radiates from the back into the legs and/or feet
- Numbness, tingling, and/or weakness in the legs and/or feet
- Trouble standing
- Pain while walking
Lumbar Spinal Fusion Alternative
A lumbar fusion alternative is often a good option for patients seeking to avoid recurring pain after spinal fusion. The TOPS System from Premia Spine is one option to correct lumbar spinal disorders while omitting the fusion process.
The TOPS System is a unique device that replaces the anatomical spinal structures removed in decompression surgery. For example, the facet joint or lamina may be removed during decompression to alleviate nerve impingement. Then, the TOPS System can be secured to the affected area to restore a stabilized range of motion.
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Since the TOPS System reestablishes motion in every direction, including extension, flexion, lateral bending, and axial rotation, patients aren’t subject to significant mobility restrictions after the procedure. Additionally, this complete range of motion removes the risk of adjacent segment disease and related complications.
Clinical studies performed since 2005 have presented the TOPS System’s ability to relieve chronic lower back and leg pain in patients with lumbar spinal stenosis and degenerative spondylolisthesis.
If you’re concerned about the possibility of pain 10 years after spinal fusion, reach out to a specialist in your area to learn more about the alternative treatment options available.
L4-L5 Fusion: Success Rate and Recovery
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Spinal fusion is a longstanding procedure that stabilizes the spine and helps alleviate symptoms of various spinal conditions. Though it may be done on virtually any part of the spine, fusion is commonly done on the L4-L5 segment of the lumbar spine.
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This article will explore the success rate, recovery process, and available alternatives for L4-L5 fusion.
What is L4-L5 Fusion Surgery?
L4-L5 fusion involves fusing the L4 and L5 vertebrae in the lumbar spine. It’s commonly performed to treat lumbar spine conditions including spinal stenosis, spondylolisthesis, disc degeneration, vertebral fractures, and herniated disc.
The spine consists of four sections: the cervical spine (the neck), the thoracic spine (the mid-back), the lumbar spine (the lower back), and the sacral spine (directly above the tailbone). Each of the vertebrae of the spine has been assigned a letter and a number according to these sections. The lumbar spine includes the L1 through the L5 vertebrae.
Spinal fusions are most commonly performed on the lumbar spine. Over 300,000 lumbar spine procedures are estimated to be performed in the United States each year.
How Long to Recover from L4-L5 Fusion?
It takes between six months and one year to fully recover from L4-L5 fusion. You may need four to six weeks to return to basic activities around the house after the procedure, and one to two months to return to work.
If your job involves light physical activity, you may need to take three to six months off of work after L4-L5 fusion. Patients whose jobs require hard physical labor generally can’t return to those occupations after the procedure.
Fusion requires such a lengthy recovery process because it involves bone healing. Bone tissue takes longer to heal than soft tissue.
How to Wash Hair After Spinal Fusion Surgery on L4-L5?
To wash your hair after L4-L5 spinal fusion, use a hand-held shower head. If you don’t have one, bend at the knees and waist to fit your head under the shower head. Make sure not to arch your back to wash your hair after fusion, as doing so may strain your spine.
Additionally, consider purchasing a long-handled shower brush before undergoing lumbar fusion. With this tool, you can wash all areas of your body without bending. Many fusion patients also benefit from using liquid soap after fusion to prevent having to pick up a fallen bar of soap.
After L4-L5 spinal fusion, basic tasks like washing your hair may be extremely difficult. To combat this, take the following steps to prepare your home before the surgery:
- Move items in your kitchen and bathroom off of the high shelves so that you won’t have to strain to reach them.
- Stock your kitchen with nutritious ready-made meals so that you don’t have to worry about cooking while you recover.
- Do all of your laundry and set out comfortable clothes to wear during the early stages of your spinal fusion recovery.
What to Expect After L4-L5 Fusion?
After L4-L5, you can expect to stay in the hospital for two to three days. Additionally, expect to experience stiffness and soreness in the lower back. Your doctor will likely prescribe pain medication to ease discomfort in the first few days or weeks after the procedure.
You’ll be advised to avoid lifting, bending, and twisting your spine for at least two weeks after L4-L5 fusion. Most patients are told to avoid lifting any objects heavier than five pounds for at least two weeks after spinal fusion.
As aforementioned, expect to take four to six weeks off of work after L4-L5 fusion (or longer, if your occupation requires physical exertion).
What is The Success Rate for L4-L5 Spinal Fusion?
The estimated success rate of lumbar spinal fusion is 70% to 90%. This rate can vary depending on the condition that the procedure’s used to treat.
How Successful is Lumbar Fusion Surgery L4-L5?
Lumbar fusion surgery at the L4-L5 spinal segment is considered a long-standing and widely successful procedure. However, the success of L4-L5 fusion depends on both the fusion of the vertebrae and the patient’s symptom improvement. Spinal fusions rarely provide a total cure for the patient’s back and leg pain.
Certain factors can reduce the chance of success in L4-L5 lumbar fusions. These factors include:
- Smoking or using other nicotine products
- Obesity
- Osteoporosis
- Some chronic conditions
- Engaging in strenuous activities during the recovery process
What Are The Risks of L4-L5 Spinal Fusion?
The risks of L4-L5 spinal fusion include:
- Failure of the bone to fuse
- Hardware failure
- Nerve injury
- Adjacent segment disease
- Lingering lower back pain
- Need for reoperation
These risks accompany the risks associated with all surgical procedures, including infection at the surgical site, thrombosis, and complications from anesthesia.
The Best Modern Alternative for L4-L5 Fusion
The best modern alternative for L4-L5 fusion is an innovative non-fusion device, such as the TOPS System. The TOPS System is a mechanical device made to be implanted between the L2 and L5 segments. It’s most often used for lumbar stenosis, degenerative spondylolisthesis, and joint arthrosis.
The TOPS System is the best modern alternative for L4-L5 fusion because it stabilizes the spine without eliminating the independent motion of the spinal segments. The device establishes a safe range of motion in the lumbar spine to preserve patients’ mobility. This is unlike spinal fusion, which eradicates the natural motion of the fused segments.
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As an alternative to L4-L5 fusion, the TOPS System can also reduce the risk of adjacent segment disease (ASD). ASD is a potential complication of spinal fusion that occurs when the adjacent segments degenerate more rapidly due to the lack of movement in the fused segment.
In one study, TOPS was found to provide clinical improvement and radiologic stability in patients with spinal stenosis and degenerative spondylolisthesis after seven years.
If you’re suffering from symptoms of lumbar spinal stenosis, spondylolisthesis, or related conditions, modern treatment options are at your disposal. Contact a local spine specialist to learn more.
When is Spinal Fusion Necessary?
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Performed since the 1900s, spinal fusion is a long-established surgical procedure used to correct spinal conditions, injuries, and deformities. It involves permanently welding two to four vertebrae using bone graft material. As the vertebrae form a single bone, the risk of spinal instability is drastically reduced.
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As a major surgical procedure that permanently reduces spinal mobility, spinal fusion isn’t considered until all conservative treatment options have been exhausted. However, spinal fusion may be necessary for certain cases of severe spinal pain.
Who is a Candidate for Spinal Fusion?
Candidates for spinal fusion typically experience severe back pain, reduced mobility, and a diminished quality of life from one of the following conditions:
- Spinal stenosis
- Spondylolisthesis
- Degenerative disc disease
- Scoliosis
- Spinal instability
- Spinal fractures
Keep in mind that your physician will also consider your medical history and the extent of your condition to determine if you’re a candidate for spinal fusion. Additionally, physicians typically don’t consider patients as candidates for spinal fusion until they’ve undergone conservative treatments for six to 12 months, to no avail.
You may not be considered a candidate for spinal fusion if you:
- Smoke, as nicotine can sabotage the healing process
- Use steroids
- Are obese
- Have diabetes or osteoporosis
What is The Best Age for Spinal Fusion?
There is no best age for spinal fusion. The procedure can be used to alleviate spinal symptoms in adults aged 20 to 80 if the patient is in good overall health.
With that said, patients who undergo spinal fusion early in adulthood are more likely to experience the effects of adjacent segment degeneration. This is because they simply have more time to develop spinal degeneration from wear and tear.
Can You Ever Bend Again After Spinal Fusion?
After spinal fusion, you’ll no longer be able to bend at the fused segment. As a result, patients’ mobility is restricted after the procedure. However, patients usually regain the ability to bend and twist the rest of the spine after the fused segment has fully healed.
Does Spinal Fusion Shorten Life Expectancy?
Spinal fusion doesn’t shorten patients’ life expectancies. The procedure may only impact life expectancy if life-threatening surgical complications, such as infection or thrombosis, occur.
However, spinal fusion can cause long-term complications, including:
- Non-union
In some cases, the vertebrae targeted during spinal fusion fail to fuse. Certain factors increase the risk of non-fusion, including smoking or vaping.
- Hardware failure
In spinal fusion, hardware including screws, plates, cages, and bolts may be used for stability. But, the stress imparted on the lumbar spine with daily motions may cause this hardware to break or loosen after spinal fusion. One study found the incidence of hardware failure after lumbar fusion to be 36%.
- Adjacent segment disease
Adjacent segment disease, or ASD, is a term used to describe new degeneration at a spinal level adjacent to the fused level. This complication can lead to persistent back pain, stiffness, weakness, numbness, and tingling.
What Are The Disadvantages of Spinal Fusion?
The main disadvantages of spinal fusion include:
- Reduced mobility
- Extensive recovery process
- Persistent pain
- Risk of complications
Reduced Mobility
As we mentioned earlier, spinal fusion eliminates all motion at the fused segment. So, patients lose the ability to bend, twist, and flex the spine at the fused segment.
Most fusions involve just two spinal levels, which is known as a two-level fusion. But, if the patient requires a three or even four-level fusion, they’ll experience more significant mobility restrictions.
Extensive Recovery Process
Unfortunately, spinal fusion requires a lengthy recovery process. After the procedure, it can take as long as four to six weeks to return to basic activities around the house. To fully recover from spinal fusion, most patients need between six months and one year.
Persistent Pain
Spinal fusion isn’t guaranteed to eliminate patients’ back pain. In one study, 10% of patients continued to experience pain at the site of the fusion five years after the procedure.
Risk of Complications
Like all forms of surgery, spinal fusion comes with a risk of complications including infection, thrombosis, and adverse reactions to anesthesia. However, it can also cause the complications listed earlier, such as hardware failure and ASD.
Premia Spine TOPS System – Alternative for Lumbar Spinal Fusion
Given that spinal fusion comes with many downsides, patients are often interested in alternatives to the procedure. The Premia Spine TOPS System is an alternative to lumbar spinal fusion that stabilizes the spine without eliminating the motion of the treated segment.
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The TOPS System is a non-fusion implant device that’s used to replace the tissues removed during spinal decompression. Soft and bony tissues are removed to alleviate nerve compression, and the TOPS System restores a controlled range of motion in the spine. This prevents spinal instability while relieving the symptoms of conditions including spinal stenosis and spondylolisthesis.
TOPS offers numerous benefits as an alternative for lumbar spinal fusion:
- Shorter recovery period
- Fewer restrictions on physical activity and a greater range of motion
- Reduced risk of adjacent segment degeneration
- Immediate pain relief
To learn more about the range of treatment options that Premia Spine offers, find a specialist in your area today.
When Premia Spine TOPS System is Not The Solution
If your spine specialist determines that the TOPS System isn’t the right solution for your symptoms or spine section, you may be asked to consider spinal fusion. Learn other spinal fusion alternatives that might work for you including:
- Artificial disc replacement
If your spinal pain is caused by a severely degenerated spinal disc, artificial disc replacement may work for you. In this procedure, the damaged disc tissue is removed and replaced with an artificial disc. There are several artificial discs available today, and your spine specialist will determine the right one for you.
- IDET
IDET, or intradiscal electrothermal coagulation, involves gently heating the exterior of a spinal disc with a needle passed through a catheter. This process is thought to boost collagen fibers in the disc exterior, leading to pain relief.
- Stem cell therapy
Stem cell therapy may help patients overcome spinal pain without fusion. This treatment involves injecting stem cells directly into the spine. Stem cells can regenerate into any type of cell and may help restore damaged spinal tissue.
Spinal fusion can make your quality of life better in separate cases, you do not have to live through daily discomfort of terrible chronic pain.
Common Problems After Spinal Fusion
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Spinal fusion is a common surgical procedure that’s done for conditions like spinal stenosis and spondylolisthesis. During the procedure, the surgeon places bone graft material between one or more vertebrae to gradually fuse them into a single bone.
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Due to the nature of the procedure, spinal fusion involves certain restrictions, complications, and problems. Fusion permanently removes all motion at the fused vertebrae, which can alter how the rest of the spine bears weight. This, combined with possible surgical complications, can (understandably) leave patients with many questions.
In this article, we’ll explore common problems from spinal fusion to consider before undergoing the procedure.
What to Expect 6 Months After Spinal Fusion?
Six months after spinal fusion, you can expect to start the final stages of the recovery process. Between six months and one-year post-op, patients can typically start returning to all of their normal activities, including some bending and twisting. During this stage, your spinal surgeon will likely be able to confirm that the vertebrae have successfully fused.
Keep in mind that even after the fused vertebrae have fully healed, patients must still adhere to certain restrictions. With all motion eliminated at the fused segment, patients can’t bend, twist, and flex as much as they used to.
Can Spinal Fusion Cause Problems Later in Life?
Spinal fusion can cause problems later in life, namely hardware failure, adjacent segment disease (ASD), or spinal muscle injuries. All of these problems can lead to new or reoccurring back pain and neurological symptoms.
Hardware Failure After Spinal Fusion
Hardware including rods, pedicle screws, cages, and spacers may be used for stability in lumbar spinal fusion. Though it’s designed for lifetime use, this hardware can wear out and break over time.
Symptoms of hardware failure are often similar to the symptoms that patients experience before spinal fusion: persistent back pain and/or weakness, tingling, and numbness.
Why Does My Back Still Hurt Years After Spinal Fusion?
If your back still hurts years after spinal fusion, it’s likely due to increased stress and degeneration of the adjacent spinal segments. Known as adjacent segment disease, or ASD, this potential complication of spinal fusion occurs when the fused segments increase the strain on the surrounding segments. This can lead to back pain and neurological symptoms years after the fusion.
What Are The Signs of a Failed Fusion?
The possible signs of a failed fusion include chronic back pain, reduced mobility, neuropathic pain, and radicular pain. With a failed fusion, the patient’s initial symptoms may return, or they may experience new problems.
- Chronic back pain
Pain is considered chronic if it’s significant, continuous, and lasts for over 12 weeks. Failed spinal fusion typically causes chronic back pain that doesn’t improve, even after the expected recovery period.
- Reduced mobility
One of the goals of spinal fusion is to improve mobility. Patients with a failed fusion may experience spinal mobility limitations that go beyond the normal restrictions associated with fusion.
- Neuropathic pain
Neuropathic pain occurs when the nerves or spinal cord become damaged. It manifests as numbness, tingling, burning, and/or weakness that may move throughout the body.
- Radicular pain
Radicular pain is a type of neuropathic pain that radiates from one part of the body to another. For example, the pain may radiate from the lower back down the buttocks and legs.
Can Spinal Fusion Cause Nerve Damage?
Yes, spinal fusion can cause nerve damage. This is because spinal surgery involves navigating delicate nerve structures, including the spinal cord and spinal nerve roots. Additionally, inflammation in the tissues surrounding spinal nerves can cause nerve damage after fusion.
Although nerve damage is possible during spinal surgery, surgeons use many different techniques to prevent this complication. These techniques include:
- Advanced imaging technology used to plan the surgery with 3D images of the patient
- Microscopes used to light and magnify the operative field
- Detailed intraoperative imaging and visualization that allows for precise instrument and implant positioning
What Are The Signs of Nerve Damage After Spinal Fusion?
The signs of nerve damage after spinal fusion include tingling, numbness, burning, and weakness. If a nerve that supplies the pelvis becomes damaged, you may also experience sexual dysfunction.
Nerve damage is a serious problem that may require immediate medical attention. If you’re experiencing signs of nerve damage after spinal fusion, contact your doctor right away.
Can Spinal Fusion Cause Paralysis?
Spinal fusion can cause paralysis, but it’s one of the rarest possible complications. It may result from one of the following problems during the procedure:
- Extradural spinal hematoma, which involves bleeding within the spinal column
- Incidental durotomy, which occurs when spinal fluid leaks
- Accidental injury to the nerves when they’re repositioned during the operation
- Accidental injury to the blood vessels that deliver blood to the spinal cord
The Best Alternative to Lumbar Spinal Fusion
The best alternative to lumbar spinal fusion is an advanced non-fusion implant, like the TOPS System. Non-fusion implants work by stabilizing the affected vertebrae with a device. In the case of the TOPS System, the device moves with the spine to create a controlled range of motion.
The TOPS System works by replacing the spinal structures removed during spinal decompression. It’s anchored to the spine and includes a patented crossbar configuration, which exerts less impact on the screws than fusion implant devices. The device recreates motion in every direction, including flexion, extension, axial rotation, and lateral bending.
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In a study of the TOPS System for lumbar spinal stenosis and degenerative spondylolisthesis, the visual analog scale (VAS) for back and leg pain lowered from 56.2 before the procedure to 12.5 at six weeks, 13.7 at one-year follow-up, 3.6 at two years follow-up, and 19 at seven years follow-up. These results showed that TOPS can continue to provide a clinical improvement over time.
Patients who are concerned about the complications from spinal fusion can speak with a specialist in their area to learn more about the available alternatives.
Is There an Alternative to Spinal Fusion?
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Spinal fusion is a surgical procedure that can correct problems in the small bones of the spine. In a sense, it’s like a welding process, but for bones instead of metal. The basic idea is that you fuse two or more of the vertebrae so that they can heal as a solid, singular bone.
The spinal fusion surgery decision is between you and your doctor. However, many people dislike the idea of having surgical procedures.
You probably want to learn how to avoid spinal fusion surgery and if there are modern spinal fusion techniques that could help you. Here, we’ll answer the popular question: What are alternatives to spinal fusion?
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Spinal Fusion Indications
Typically, spinal fusion surgery is done for mechanical low back pain. Often, the pain you experience increases with various activities and could be related to degenerative disc disease. Sometimes, it occurs from low-grade slippage of your spinal bones, such as with isthmic spondylolisthesis and degenerative spondylolisthesis.
Most doctors recommend surgery as a final option if no other treatment has helped. Other indications for spinal fusion can include:
- Tumors
- Fractures
- Spinal stenosis
- Scoliosis
Spinal Fusion Pros and Cons
The benefits of spinal fusion are plentiful. This is particularly true for those who live with back pain every day. This can diminish your quality of life. But, ultimately, good candidates for spinal fusion therapy are those who could damage their spinal cord and become paralyzed.
However, there are risks involved with any surgical procedure. You could develop an infection, profuse bleeding, nerve damage, or blood clots. With spinal fusion, you could feel immense pain in the area where the bones are fused. Sometimes, patients even have poor bone formation, so the fusion isn’t successful.
These cons are key deciding factors for patients considering alternatives to spinal fusion for scoliosis and other spinal conditions.
How Serious is Spinal Fusion Surgery?
Patients often inquire about the seriousness of surgical procedures before considering them. Spinal fusion is a very serious surgical procedure that must be performed by a qualified neurosurgeon or orthopedic surgeon. Additionally, surgeons generally have a complete surgical team for assistance throughout the procedure.
As aforementioned, all surgical procedures involve a degree of risk. Most surgeries present the risk of blood clots, bleeding, pain, infection, and complications from anesthesia. Other potential complications from spinal fusion include:
- Nerve injury, which can cause numbness, tingling, and/or weakness in the extremities
- Pseudoarthrosis, which occurs when the bone doesn’t fuse properly and the patient must return for another surgery. This complication is more likely among patients who exercise too soon after the procedure, smoke, or have diabetes.
- Returning symptoms, which occur when a spinal fusion isn’t effective the patient’s back pain comes again within a few months
How Painful is a Spinal Fusion?
As an invasive procedure involving bone formation, spinal fusion generally causes significant pain during the recovery process. However, your spine specialist can prescribe pain medications to help you get through this period.
In the days and weeks immediately after spinal fusion, your back will likely feel sore and tight. It may be difficult to stand or sit in the same position. Additionally, you may need four to six weeks to return to basic day-to-day tasks.
Four weeks following spinal fusion, the worst of your post-operative pain should be over. Although you may still have some pain, it will continue to gradually improve. In some cases, patients experience pain after spinal fusion three to six months following the procedure.
Post-operative pain from spinal fusion requires patients to take time off of work. Patients with professions that don’t involve physical labor can typically go back to work within one to two months. However, patients with professions that involve light physical labor may need to take three to six months off of work.
Why You Shouldn’t Get a Spinal Fusion
An increasing number of patients are opting not to get a spinal fusion and instead choosing spinal fusion alternatives. Key reasons to not get a spinal fusion include:
Lost Spinal Mobility
Possibly the most prominent downside of spinal fusion is lost spinal mobility. When the targeted vertebrae are fused, all mobility in that spinal segment is lost. This means that the patient loses the ability to bend, flex, and twist that area of the spine.
You may be surprised at how many day-to-day activities are dependent on the flexibility of the spine. Whenever you bend down to pick up an object off of the floor or reach upward to retrieve an object from a high shelf, your spine moves to complete the task. So, with a fused spinal segment, you may lose the ability to perform various tasks.
Besides routine motions, lost spinal mobility can significantly shorten the list of physical activities and sports that you can partake in. After spinal fusion, many patients lose the ability to participate in their favorite form of exercise.
Risk of Continued Pain and Degeneration
Unfortunately, spinal fusion doesn’t promise complete symptom relief. Some patients continue to have back pain after undergoing fusion.
Additionally, fusion creates the risk of accelerated degeneration in the neighboring spinal segments. This can lead to further pain and neurological symptoms down the road.
Possible Complications
As we mentioned above, spinal fusion comes with a sizable risk of complications. This is true of any surgical procedure. But, given that spinal fusion involves the spine, which contains many nerves and the spinal cord, this presents the added risk of nerve injury.
What Can Be Done Instead of a Spinal Fusion?
Now that we’ve gone over the downsides of spinal fusion, let’s answer a crucial question: What are the alternatives to spinal fusion surgery?
Spinal Fusion Alternatives
IDET
IDET stands for intradiscal electrothermal coagulation. It may be one of the effective alternatives to spinal fusion surgery for lumbar disc degeneration.
During the IDET procedure, your provider will insert a needle into the lumbar disc area. Then, a catheter is passed through the needle and the disc’s outer shell is gently heated.
This non-surgical process may alleviate pain by bolstering collagen fibers in the disc exterior. Thickened collagen fibers may repair cracks in the disc exterior and provide pain relief for some patients.
Regenerative Medicine
Regenerative medicine is an emerging field that may be implemented for certain cases of chronic back pain. Stem cell therapy is a treatment that falls under the categories of regenerative medicine and spinal fusion surgery alternatives.
Stem cells can regenerate into virtually any type of cell in the body. In stem cell therapy, stem cells from the patient or a donor are injected directly into the area with damaged tissue (such as a damaged intervertebral disc). Over time, the stem cells will work to repair the tissue and alleviate the patient’s pain.
There is still research to be done on the efficacy of regenerative treatments for back pain. However, it may soon be considered one of the successful alternatives to spinal fusion for spondylolisthesis and other spinal conditions.
Dynamic Stabilization Systems
Dynamic stabilization systems differ from spinal fusion in that they aim to stabilize the spine while preserving spinal motion. This spinal fusion alternative involves securing a specialized device to the affected spinal segment, typically after spinal decompression.
The TOPS System is one dynamic stabilization system that’s one of the effective alternatives to lumbar spinal fusion available today.
TOPS for Spinal Fusion
The TOPS System is a spinal implant that can stabilize the area without having to fuse together the diseased vertebrae. That way, you can relieve the pain from your condition without spinal fusion surgery.
Typically, TOPS works well for spinal stenosis, which narrows the spinal canal and causes nerve roots and spinal cord compression. TOPS can also be used for degenerative spondylolisthesis, which involves the displacement of a spinal bone.
Ultimately, the TOPS System can be used for L3 to L5 vertebrae. You can also use it with the Premia Fixation system to address various spine diseases. Modern spinal fusion techniques like this are still being tested and studied. However, the indications are good that it could be a superior treatment option to traditional spinal fusion.
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It’s important to note that the TOPS System still involves surgery. When the decompression is complete, the surgeon uses the TOPS System to replace any extracted bone and stabilize your spine. The surgeon can remove all of the elements that press on the nerve roots without requiring enough bone to fuse them together.
Instead of locking those two vertebrae together permanently, the TOPS implant allows them to function normally. This system ensures full motion but prohibits the patient from excessively turning and twisting. The result is that you preserve your motion, have optimal decompression, gain spine stability, and experience pain relief.
Most patients experience immediate pain relief after the procedure. Plus, you can walk around and be on your feet the next day. There’s less movement restriction because no bone fusion occurs in the lower back.
Description of the Device
TOPS for spinal fusion is one of the many modern spinal fusion techniques out there. The device is just a mechanical implant, and it’s a great surgical alternative to traditional spinal fusion. If you have moderate or severe lumbar spinal stenosis or related spinal problems, you can benefit from this option.
You no longer have to worry about the drawbacks of spinal fusion because the TOPS System addresses the two most critical spinal functions – preserving motion and maintaining stability. With the Posterior Arthroplasty procedure, a surgeon removes the bones that press on your nerves. Once this process is complete, the doctor can implant the TOPS System to reestablish a controlled movement range and stabilize the spine.
If you have spinal stenosis symptoms (sciatica, low back pain, or leg pain while walking), you can ultimately regain the ability to flex, bend, and walk.
The Benefits of TOPS
With the TOPS System, you can move in all directions. This includes axial rotation, lateral bending, extensions, and flexion. However, it also works to block the sheer forces that are naturally exerted in the lower spine and could be quite painful.
The TOPS System is clinically proven to offer sustained and immediate pain relief while improving your quality of life. There are three primary benefits of using TOPS to treat spinal stenosis:
- This procedure can stabilize your posterior spine to help reestablish a controlled range of motion.
- Patients can bend, walk, flex, and enjoy their normal activities.
- People can experience immediate pain relief that continues for a long time.
Clinical studies have been conducted since 2005, and they all show that the TOPS System can alleviate persistent low back and leg pain in patients with moderate or severe spinal stenosis or spondylolisthesis.
How It Works
TOPS for spinal fusion is the mechanical implant device that can replace the soft and bony tissues that the surgeon must remove or that become compromised during spinal decompression surgery. Alternatives to spinal fusion like this have a higher success rate and fewer associated risks.
Ultimately, this surgery can be used to treat lumbar spinal stenosis, which is the narrowing of your spinal canal. However, the TOPS System can only be used on the lumbar segments between L3 and L5. These are the segments that are most commonly affected by spinal stenosis.
In general, the TOPS System can be the transitional segment between your disease-free spine segments and the rigid fixation of normal fusion techniques.
TOPS uses two titanium endplates, which house a centralized artificial articulation. This means that you can move around in all directions – lateral bending, axial rotation, flexion, and extension as if you had a healthy, normal spine. Therefore, patients can easily straighten up, twist, and bend at the spine level, even if they have spinal stenosis of the lumbar spine.
A traditional posterior surgical procedure is used to implant the device, which stabilizes the affected vertebrae. Spinal decompression surgery can be used to remove the diseased facet joints and lamina and replace them with the TOPS System.
As with other modern spinal fusion techniques, the TOPS System gets anchored to the spine using four screws. However, it features a unique and patented crossbar to exert less force on those screws. Before making your spinal fusion surgery decision, consider TOPS as one of the alternatives to the spinal fusion of the lumbar region.
Steps For Faster And Easier Spinal Fusion Surgery Recovery
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Spinal fusion is a relatively common surgical procedure used for spinal conditions and deformities. It’s widely used to prevent spinal instability after spinal decompression surgery, which may be used for spinal stenosis, spondylolisthesis, herniated disc, and related medical concerns.
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- How To Get Prepared For Lumbar Spinal Fusion Surgery?
- How Long After Spinal Fusion Does It Stop Hurting?
- How Can You Make Your Lumbar Spinal Fusion Heal Faster?
- Are There Any Permanent Restrictions After Spinal Fusion?
- Should I Consider Avoiding Spinal Fusion?
Regrettably, spinal fusion surgery involves a lengthy recovery period that can last from six months to a year in total. With this in mind, many patients seek out ways to shorten their recovery and get back on their feet faster.
In this article, we’ll explore strategies for shortening your spinal fusion surgery recovery and maintaining lasting pain relief.
How To Get Prepared For Lumbar Spinal Fusion Surgery?
Preparing for lumbar spinal fusion is the first (and arguably most important) step in shortening your spinal fusion recovery. Here are our best tips to ready yourself for the procedure:
- Talk to your doctor about every medication and supplement that you’re currently taking. This includes not only prescription drugs but also over-the-counter medications and even herbal supplements. Patients may be required to stop taking specific medications before fusion to ensure that the procedure and their recovery process go off without a hitch.
- If you smoke, quit as soon as possible. Smoking is detrimental to the body’s healing process, increases the risk of complications, and diminishes the success rate of spinal fusion. You can consult your physician for resources to help you quit smoking, as well as your loved ones for support.
- Optimize your diet. Consuming a nutrient-dense, fiber-rich diet before and after spinal fusion promotes healing and prevents constipation, which can be caused by prescription pain medications. Limit processed, high-fat, and high-sugar foods.
- Prep your kitchen with ready-made and throw-together meals. Make sure that everything you’ll need in the kitchen is on a shoulder-height shelf, as you won’t be able to reach or bend after the spinal fusion procedure.
- Gather any equipment that you may need, such as a cane, toilet seat riser, and reacher tool.
- Ask friends and family members for support. You’ll need a ride home from the hospital after the procedure, and it may be helpful to have a loved one stay with you for assistance during the first few days at home. You can also contact an in-home caregiver to help you during this period.
How Long After Spinal Fusion Does It Stop Hurting?
After lumbar spinal fusion, the most severe pain typically abates after four weeks. Following this benchmark, you may still experience pain, but it should gradually diminish with time.
Patients may continue to feel some degree of pain three to six months after spinal fusion. Physical therapy and healthy lifestyle habits can help you manage this pain as you recover from the procedure.
How Can You Make Your Lumbar Spinal Fusion Heal Faster?
There are a handful of ways to accelerate healing after spinal fusion, including:
- Following all of your surgeon’s recommendations. After the fusion procedure, your surgeon will offer basic guidance on what to do and what to avoid. Following these instructions carefully will benefit your recovery process.
- Keeping a close eye on the incision. Identifying signs of inflammation, irritation, or discoloration as soon as possible will help ensure that any complications are addressed promptly.
- Staying mobile after the procedure. While following all of your doctor’s guidance, get up and walk around during your spinal fusion recovery. Doing so will keep blood circulating throughout your body, prevent atrophy, and reduce your risk of blood clots.
- Refraining from smoking. As important as it is to quit smoking before spinal fusion, it’s also crucial to avoid smoking throughout your recovery process, as smoking can speed up spinal degeneration.
What Foods Are Good For Healing After Spinal Fusion Surgery?
As mentioned in a prior section, high-fiber, nutrient-dense foods are ideal for patients undergoing spinal fusion. Here are other dietary recommendations to consider after spinal fusion surgery:
- Pack your diet with lean protein.
Protein is essential for healing after surgery. So, pack your diet with plenty of low-fat protein, including poultry, fish, lean meat, eggs, low-fat dairy, and tofu. As a bonus, foods that are high in protein also typically contain high amounts of zinc, which supports your body’s ability to fend off infection.
- Pair fiber-rich foods with plenty of water.
To prevent constipation after spinal fusion, eat fiber-rich foods including vegetables, fruits, and whole grains. Prunes and prune juice are also helpful, as they act like natural laxatives. Make sure to wash down these foods with plenty of water to support your digestive system during the recovery period.
- Consume more calories.
After spinal fusion surgery, your metabolism kicks into high gear to accommodate the body’s healing process. To fulfill this heightened demand, you’ll need to consume more calories, ideally through nutritious foods including fruits, vegetables, legumes, and whole grains.
Are There Any Permanent Restrictions After Spinal Fusion?
The spinal fusion procedure permanently fuses the targeted vertebrae of the spine. This process also permanently eliminates all motion at the affected segment. So, patients do experience permanent restrictions on their mobility, such as an inability to twist, bend, and lift heavy objects.
In some cases, patients need a reacher tool to retrieve objects from the floor or on high shelves after spinal fusion. With a significant loss of spinal flexibility, patients may lose the ability to participate in some of their favorite physical activities.
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Should I Consider Avoiding Spinal Fusion?
The lost mobility, risk of complications, and lengthy recovery period associated with spinal fusion lead many patients to consider avoiding lumbar spinal fusion altogether. While in past decades this may have been a challenge, there are currently spinal fusion alternatives available to the public.
Non-fusion spinal implants like Premia Spine’s TOPS System provide stability after spinal decompression surgery without fusing the vertebrae. This results in a controlled range of motion without the extensive recovery and lost mobility of fusion.
Before undergoing fusion, don’t hesitate to contact your spine specialist to discuss every available treatment option for your spinal condition.