Preparing for Spinal Fusion Surgery, Part II

In our last blog we began addressing the topic of preparing for spinal fusion back surgery.  We touched upon tests that may be performed, and the need to prepare physically through a conditioning regimen so your body is ready for the rigors of surgery. Here are additional points anyone considering spinal fusion should remember:

One potential complication of spinal fusion surgery is excessive bleeding. Several commonly used medications can increase bleeding, including aspirin, ibuprofen and other NSAIDs, as can anticoagulants such as warfarin. You will need to discontinue use of any such medications. Should your physician or surgeon be concerned about the risk of excessive blood loss during your spinal fusion operation, you may bank your own blood, called an autologous blood donation, before the surgery.

Be sure to discuss all the medications you are taking with your physicians, and they will advise you when (and if) you should stop taking them. Some medications could cause adverse affects in combination with the anesthetics or other medications used during the operation, and anti-inflammatory medication such as cortisone and chemotherapy can compromise the body’s ability to heal.

Failure of the bone graft to heal, called pseudarthrosis, is one of spinal fusion’s most problematic post-surgical complications. Smoking is associated with this complication, and nicotine has been shown to compromise the ability of bone cells to grow. It is imperative that smokers stop smoking prior to the surgery, and not smoke before their recovery is complete.

Before resigning yourself to spinal fusion surgery, remember that spinal problems often respond to more conservative treatments, such as physical therapy and healthy lifestyle changes. Alternative surgical procedures may also be available. For example, many candidates for spinal fusion can choose the TOPS^TM(Total Posterior Solution) System instead. The TOPS System not only preserves all the natural flexion of individual vertebrae, unlike spinal fusion, but it has also been shown to have better outcomes in clinical trials around the world. Indeed, investigating alternative options is another productive way to prepare for a spinal fusion operation.

How to Prepare for Spinal Fusion Back Surgery

 

Spinal fusion back surgery is often performed in conjunction with spinal decompression treatment. The decompression procedure relieves pressure on pinched nerves emanating from the spine, reducing pain and restricted mobility in limbs caused by the compressed nerve. But the spinal decompression surgery involves removing portions of vertebrae, making the spine weaker at these points. Thus, spinal fusion surgery is performed to strengthen the spine after decompression, and involves fusing two adjacent vertebrae with the use of an implant.

Preparing for spinal fusion surgery – whether performed on the lumbar, thoracic or cervical spine – is similar to preparations for any spinal operation, but there are a few specifics to be aware of. First, be prepared to be thoroughly examined before the surgery is performed, so your physicians can plan all aspects of your operation. Radiograph assessments of spinal instability, EMG to test nerve function, and an MRI, CAT, or other scan is often performed to identify nerve compression.

Your overall physical condition will also be assessed to ensure you are in sufficient health to undergo the rigors of the surgery. You will need to discuss any and all pre-existing medical conditions with your physicians, and further evaluation of such conditions may be necessary before proceeding with spine fusion surgery. In fact, one of the most important ways to prepare for spinal fusion is to get into the best physical condition possible. Being in good physical condition translates into fewer complications during surgery and faster recoveries after, among other benefits.

Spinal surgery of any kind should be considered a last resort, undertaken only if more conservative treatments have proven ineffective. But many patients undergoing spinal decompression now have an alternative procedure to spinal fusion, shown in clinical tests around the world to have better outcomes than spinal fusion. The TOPS^TM (Total Posterior Solution) System stabilizes the spine without eliminating the independent motion of the individual vertebrae, as spinal fusion does. So one of the best ways to prepare for spinal fusion is to find out if an alternative solution like TOPS makes more sense than spinal fusion surgery for you or a loved one.

Back Pain and Steroid Injections

Epidural injections of steroids have often been the treatment of choice for patients with a pinched nerve in the back whose symptoms did not respond to simple exercise, physical therapy, or other more conservative approaches. Steroid injections have also been offered to patients with spinal stenosis whose back pain was unrelieved by less invasive therapy. But the results of a new research study hint that injections of steroids for back pain may be less beneficial than believed. The study is small, but it still bears consideration, as the findings are statistically valid and underscore why healing is as much an art as a science.

The study of the efficacy of steroid injections for back pain examined more than 270 patients, aged 53 to 75 years old, culled from the ranks of a larger study of individuals with spinal health problems. The research subjects were followed for four years. Sixty-nine of these patients had epidural injections and 207 did not, but otherwise the patients’ symptoms were primarily the same in terms of severity, as measured by well-established scales used to measure pain in the leg and lower back. Using these scales, researchers found less improvement among those who had epidural injections than among patients who did not have injections.

Several caveats must be offered when considering the results of this research. First, as the authors readily acknowledge, factors that the researchers didn’t account for and couldn’t control may have affected or skewed the results. Nonetheless, we are seeing fresh thinking and new techniques improving outcomes for many spinal patients. For example, patients who elected to have spinal decompression surgery to relieve symptoms of pinched nerves typically opted for a spinal fusion back surgery in tandem, in order to stabilize the spine. Today, a growing number are opting for TOPS^TM – the Total Posterior Solution – System, instead of spinal fusion. The TOPS system, unlike spinal fusion, preserves complete independent motion of the individual vertebrae. This is one more way that fresh thinking, and new technologies and procedures are transforming the care and treatment of back problems.

Recovering from Lumbar Spinal Stenosis

Lumbar spinal stenosis, a common medical problem, denotes an unnatural narrowing of the spinal canal, the center of the spinal column housing the spinal nerves that relay sensorial information to the brain and control the movements of our muscles. The term stenosis comes from Latin, and means a narrowing. When a portion of the spinal canal narrows unnaturally, it can put pressure on the spinal nerves, and these pinched nerves in turn can cause pain and limit mobility.

The good news is that a variety of treatment options are available that have been proven effective in helping individuals recover from or ameliorate the symptoms of spinal stenosis. Conservative, non-invasive therapies include simple lifestyle changes, medications, physical therapy, and injections of anti-inflammatory agents. For patients with spinal stenosis, there’s no way of knowing which of these approaches will be most successful, so physicians may simply prescribe one of these treatments as a first step, and monitor the results to see how the patient responds. If the first method selected doesn’t achieve the results of helping the patient recover from spinal stenosis, the next option may be tried, and so on.

For patients with moderate to severe spinal stenosis who do not respond to conservative treatments, surgery may be recommended. In this form of spinal decompression surgery, the surgeon trims away excess bone in the narrowed center of the affected vertebra, relieving pressure on the compressed nerve or nerves. Historically, a spinal fusion back surgery operation has been performed in conjunction with surgery to relieve spinal stenosis, in order to stabilize the region of the spine where the operation was performed. Today there’s an important, and better alternative to spinal fusion. The TOPS (Total Posterior Spine) System procedure provides better clinical outcomes than spinal fusion surgery. The TOPS solution has the added benefit of preserving the spine’s full range of motion, unlike spinal fusion, which permanently fuses adjacent vertebrae. TOPS also offers a much quicker recovery from surgical treatment for spinal stenosis than spinal fusion. If you’re a candidate for spinal stenosis surgery, make sure you understand all the advanced surgical solutions available today, and what impact each will have on your recovery from this condition.

Back Treatment Options

In our previous blog we discussed the tremendous stresses borne by the lumbar, or lower portion of the spine comprising the five lowest vertebrae. In fact, lumbar back pain is a significant health issue, affecting about 70 to 85 percent of Americans at some point in their lives, according the National Institutes of Health (NIH). Among the most common causes of lumbar spinal problems is the degeneration of bones and tissue in the spine that occur as a normal part of aging. But one doesn’t have to be older to have lumbar spinal problems. Back pain is the most frequent cause of activity limitation in people under the age of 45, according to the NIH. Trauma or injury, poor posture and biomechanics, genetics, obesity and poor muscle tone can all result in lumbar spinal problems that cause pain, limit mobility, and have other serious health consequences. These conditions include spinal stenosis, bulging disc, herniated disc, slipped disc, radiculopathy and spondylolisthesis.

A variety of treatment options are available for individuals affected by conditions causing lumbar back pain. Individuals with moderate to severe cases of these conditions who do not respond to conservative treatment options such as medication, physical therapy and lifestyle changes, may opt for a surgical solution. Frequently this involves cutting away portions of a lumbar vertebra that is impinging, or putting pressure on a nerve emanating from the spinal column. Such spinal decompression surgery can have a dramatic impact on relieving pain and restoring mobility. However, removing bony elements also weakens and destabilizes the spine, so historically a procedure known as lumbar fusion, or lumbar spinal fusion has been performed in conjunction with spinal decompression back surgery of the lower spine. In this procedure the vertebra from which tissue was removed is fused to an adjacent vertebra. This stabilizes and strengthens the spine, but lumbar fusion eliminates the natural flexion and independent motion of the fused vertebrae. Today lumbar decompression surgery patients have an alternative to lumbar fusion: the TOPS™ (Total Posterior Spine) System. TOPS preserves the full range of the spine’s natural motion, and has been shown to provide better outcomes than fusion in clinical studies performed around the world. If you are considering surgery for a lumbar spinal problem, ask your physician about all your surgical options.

What is Lumbar Spinal Decompression?

Imagine if the branches of a tree were just as big at the top as they are at the bottom, and that sometimes, heavy loads were placed on the ends of the very highest branches. Think of the stress that would put on the lower portion of the tree trunk. Well, that’s analogous to the situation we humans experience with our spinal columns. Our spinal column is like the trunk of a tree, but we’re just as big at the top of our trunks as at the bottom. The stress this puts on our lower backs – also called the lumbar region of the spine – is exacerbated by the cumulative affect of a lifetime of lifting and twisting in combination with degenerative changes of the spine that occur as a result of aging. So it’s not surprising that the majority of back problems that bring patients to spinal specialists are centered in the lower, or lumbar region of the spine.

These stresses, along with our genetic makeup, disease or injury, can result in a host of spinal disorders such as bulging or herniated discs, slipped disc and spinal stenosis. These disorders, in turn, can result in unnatural pressure being put on nerves that emanate from the spinal column, potentially causing pain, restricted mobility, and other symptoms of pinched nerves. We talked about the problem of pinched spinal nerve and spinal decompression in general in a previous blog. As we noted, spinal decompression is a means of easing pressure on impinged spinal nerves, and can be performed either non-surgically or surgically. Lumbar spinal decompression simply refers to decompression procedures performed on the lower portion of the spine.

The surgical solution for a lumbar pinched nerve involves removing tissue from vertebrae in the lumbar region that impinge, or put pressure on a nerve. This is called lumbar spinal decompression surgery. Historically, spinal fusion back surgery has been performed in conjunction with lumbar decompression surgery to stabilize the spine. Today, the TOPS™ (Total Posterior Spine) System provides an alternative to spinal fusion that preserves the full range of the spine’s natural motion, and has been shown to provide better outcomes than fusion in clinical studies performed around the world. This provides an important more treatment option for individuals with moderate to severe symptoms of pinched nerves who do not respond to non-surgical lumbar decompression procedures.

What is Spinal Decompression?

It may sound like something only a deep sea diver needs to be concerned about, but spinal decompression is an important topic for many people suffering from debilitating back pain. Spinal decompression refers to the process of relieving pressure on one or more pinched, or impinged nerves in the spinal column. The pressure on such nerves can cause pain, restrict mobility, and result in a host of other physical problems that can manifest in almost any part of the body. A host of spinal conditions, including spinal stenosis, disc degeneration, bulging, herniated or slipped discs, and facet syndrome can put pressure on nerves emanating from the spinal column.

Spinal decompression can be performed both surgically and non surgically. Non-surgical spinal decompression utilizes mechanical, computer controlled traction devices to reduce the pressure placed on nerves in specific portions of the spine. Inversion therapy, in which patients hang upside down, is another from of non-surgical spinal decompression.

For patients who do not respond to non-invasive methods, spinal decompression surgery can achieve dramatic improvements. In this surgical procedure, portions of the bone or tissue of the spine that impinge of a nerve are cut away, relieving the pressure. Historically, a spinal fusion procedure was performed in conjunction with spinal decompression surgery, in order to stabilize the spine at the point where the decompression procedure was performed. But spinal fusion, in which two vertebrae are fused to enhance spinal stability, eliminates the independent motion of the fused vertebrae, and may accelerate degeneration of adjacent vertebrae. Today, the TOPS™ (Total Posterior Spine) System provides an alternative to spinal fusion for patients undergoing spinal decompression back surgery. Unlike spinal fusion, TOPS preserves the full range of the spine’s natural motion, and has been shown to provide better outcomes than fusion in clinical studies performed around the world.

If you’re a patient whose pinched spinal nerve is not responding to non-invasive decompression methods, make sure you discuss all your surgical options with your physicians.

What is Lumbar Spinal Stenosis?

Spinal stenosis – one of the most common spinal conditions – is an abnormal narrowing of the spinal canal. (“Stenosis” refers to a narrowing, or constriction.) As the spinal canal progressively narrows over time, it puts pressure on the nerves branching out from the spine, causing pain, tingling, and numbness in the extremities. The condition can occur in the lower, or lumbar region of the spine – lumbar spinal stenosis, which is the most common form – or in the neck, or cervical region of the spine – cervical spinal stenosis.

The majority of cases of spinal stenosis develop for unknown reasons, but the causes of spinal stenosis can be traced to several components of spinal anatomy, including the intervertebral discs, the facet joints that connect the vertebrae to each other, and the spinal cord. The narrowing of the spinal canal may result from abnormal bone growth and/or tissue growth, or due to a hereditary disorder. Maintaining a healthy lifestyle including exercise, good nutrition and maintaining proper weight can help prevent spinal stenosis.

Options for treatment of spinal stenosis include spinal stenosis exercises, physical therapy that can relieve pressure on the spinal cord, and medication to reduce pain and inflammation. In extreme cases, surgery for spinal stenosis may be recommended. The surgery removes potions of the vertebrae that are impinging on the roots of nerves emanating from the spine. Following this spinal decompression procedure, spinal fusion back surgery has traditionally been performed to stabilize the spine. Unfortunately, this stabilization procedure eliminates the independent motion of the fused vertebrae, and can contribute to the deterioration of adjacent vertebrae. Today, the TOPS™ (Total Posterior Spine) System provides an alternative to spinal fusion that maintains the spine’s full range of motion, and that has been proven in clinical studies conducted worldwide to provide superior outcomes than spinal fusion following spinal decompression surgery. So patients seeking surgical relief for an abnormal narrowing of the spine now have access to a wider range of treatment options than ever.

What is Neural Claudication?

Recently we addressed the topic of claudication, pain typically felt in the legs as a result of vascular, or blood vessel problems, or back problems such as spinal stenosis that can result in pinched nerves in the lower back. Neurogenic claudication is a common symptom of lumbar spinal stenosis, an abnormal narrowing of the spinal canal in the lumbar, or lower portion of the spine. Neurogenic refers to the problem’s genesis in the nerves, and claudication, Latin for limp, refers to the painful weakness or cramping the patient feels in his or her legs. Neurogenic claudication can be bilateral (in both legs) or unilateral (in one leg).  The pain may be triggered by walking or prolonged standing, and is typically alleviated by changing position or flexion of the waist, not simply by resting, as happens with vascular claudication.  In severe cases, the pain may be persistent. Bone spurs, bulging discs and herniated discs can also cause neurogenic claudication.

Conservative treatments such as physical therapy, medications and injections may be sufficient to relieve neurogenic claudication, but surgery may be recommended in moderate to severe cases that don’t respond to conservative protocols. Spinal decompression surgery is typically performed to remove portions of the vertebrae impinging on a nerve. This pinched nerve is the source of the pain, weakness and cramping of neurogenic claudication. Following the spinal decompression treatment, a secondary operation is performed to stabilize the spine in the area where vertebral material was removed. In the past, spinal fusion back surgery was the sole available surgical stabilization procedure performed with spinal decompression. However, spine fusion surgery eliminates the natural independent motion of the fused vertebrae, and can contribute to deterioration of adjacent vertebrae. Now the TOPS (Total Posterior Solution) System provides an alternative to spinal fusion that preserves the full range of natural motion of each vertebrae. If you experience pain that interferes with your quality of life, seek qualified medical help. Today’s advanced procedures provide excellent outcomes. Get the facts about all your treatment options.

Preparing for Spinal Surgery

Whether for a slipped disc caused by the normal aging process, or to treat a traumatic spinal cord injury, spinal surgery is never undertaken lightly. When selected as the preferred treatment option, it’s an indication of the severity of the problem being addressed. Back surgery is performed with the expectation that it offers a reasonable expectation of a meaningful improvement in one’s medical condition, and those improvements include reduction of pain and restoration of movement. So there’s actually much to look forward to when preparing for a back surgery operation! Here are things any patient can do to ensure the surgery and recovery goes as smoothly as possible:

Get in the best shape you can – mentally and physically. Exercise and eat a healthy diet. Lose weight, as extra weight puts mechanical stresses on the back and can complicate back surgery and recovery.  Lose weight sensibly!  If you smoke, now is the time to quit! If you won’t quit, you will have to stop prior to surgery, due to the many serious health risks the results of smoking can cause for surgical patients. Talk to your doctor about the medications you are taking. Be very thorough – even herbal supplements can impact recovery or interact with other medication prescribed for surgery.

Also, prepare for surgery by learning as much as you can about all facets of your spinal condition, and its treatment. For example, the last few years have seen dramatic advances in spinal procedures that can  provide dramatically improved clinical outcomes. The TOPS™ (Total Posterior Solution) System, often used in the treatment of spinal stenosis, spondylolisthesis, and other back problems that can cause a pinched nerve, is one such advanced procedure. TOPS is an implant system approved for use as an alternative to spinal fusion back surgery following a spinal decompression procedure. The TOPS System preserves the independent flexion and bending of the individual vertebrae following spinal decompression therapy, unlike fusion spine surgery, which eliminates this independent motion and can contribute to deterioration of adjacent vertebrae. The TOPS System has also been shown in clinical studies conducted around the globe to provide better short- and long-term outcomes than spinal fusion.

Make sure you learn all you can about your condition, and understand all your surgical options, thoroughly discuss your treatment with your physician, and you’ll be well prepared for your back surgery!