Spinal fusion is a surgical procedure in which two or more vertebrae are joined or fused together. Fusion surgeries typically require the use of bone graft to facilitate fusion. This involves taking small amounts of bone from the patient’s pelvic bone (autograft), or from a donor (allograft), and then packing it between the vertebrae in order to “fuse” them together. This can be accomplished either posteriorly or between the vertebral bodies. When it is done between vertebral bodies, bone graft, along with a biomechanical spacer implant, will take the place of the intervertebral disc, which is entirely removed in the process.
Spinal fusion surgery is a common treatment for such spinal disorders as spondylolisthesis, scoliosis, severe disc degeneration, or spinal fractures. Fusion surgery is usually considered only after extensive non-operative therapies have failed. Two common fusion surgeries available at World Class Neurosurgery Hospitals in India for Spinal Disorders include posterior fusion and interbody fusion such as PLIF, TLIF.
In Posterior lumbar interbody fusion, the spinal fusion is achieved through a surgical incision made on the posterior (back) aspect of spine. It aims at fusion of two adjacent vertebrae in cases of spinal instability and associated back pain. It is a popular procedure as it gives excellent results. Major medical journals document that the procedure provides almost complete relief of symptoms in 90-95% of the cases and the patients are able to return to their daily activities within a few weeks. The patients can also return to most of their recreational activities.
PLIF surgery aims at achieving spinal stability through bony fusion by two ways:
The Open PLIF is the traditional technique which is performed using general anesthesia. The patient is made to lie down on his front side on the table with the low back exposed. A 3-6 inch long incision is made on the skin overlying the affected vertebrae. The skin and the fascia are cut open. The underlying muscles are retracted and the affected vertebrae are identified. Fluoroscopic X-ray is used to confirm the exact location of the affected vertebrae. Then a complete laminectomy (removal of the lamina of the vertebrae) followed by bilateral foraminotomy (enlargement of the foramen by removing the bony spurs) and/or discectomy (removal of offending disc) are performed. This relieves the compression off the spinal nerves, allowing them to come to their normal size and shape. The area is checked for any remaining bony outgrowth or disc fragments that may compress the nerves. Autogenic bone grafts or Metal or plastic implants are fitted in the empty disc space for initiating bone growth. Finally, pedicle screws are placed into the upper and lower vertebrae and connected with rods or plates. New bone is allowed to grow over these rods, helping to bridge the adjacent vertebrae and achieving interbody fusion. The total surgery time is approximately 3 to 6 hours, depending on the number of spinal levels involved.
The other method is the Minimally Invasive PLIF procedure which is performed using x-ray guidance. 2.5-cm incisions are made on either side of the lower back. The muscles are gradually dilated and tubular retractors inserted to allow access to the affected area of the lumbar spine. The lamina is removed to allow visualization of the nerve roots. The offending disc material is removed from the spine and replaced with a bone graft and structural support from a cage made of bone, titanium, carbon-fiber, or a polymer, followed by placement of rod and screws. The tubular retractors are removed, allowing the dilated muscles to come back together, and the incisions are closed. This procedure typically takes about 3 to 3 ½ hours to perform. There was less blood loss, tissue trauma, operative time, and quick recovery in this procedure as compared to the traditional one.
A transforaminal lumbar interbody fusion (TLIF) is a type of spine surgery that involves approaching the spine from the back, or posterior, of the body to place bone graft between two vertebrae. The procedure may be performed using minimally invasive surgical techniques.
Spinal Access and Bone Removal
First, your surgeon will make a small incision in the skin of your back over the vertebra(e) to be treated. Depending on the instrumentation to be used, the incision could be as small as approximately 3 centimeters. In a traditional open TLIF, a 3- to 6-inch incision is typically required.
The muscles surrounding the spine will then be dilated to allow access to the section of spine to be stabilized. After the spine is accessed, the lamina (the “roof” of the vertebra) is removed to allow visualization of the nerve roots. The facet joints, which are directly over the nerve roots, may be trimmed to give the nerve roots more room.
Bone Graft Material Placement
The nerve roots are then moved to one side and the disc material removed from the front (anterior) of the spine. A bone graft is then inserted into the disc space. The bone graft material acts as a bridge, or scaffold, on which new bone can grow. Screws and rods are inserted to stabilize the spine while the treated area heals and fusion occurs, and the ultimate goal of the procedure is to restore spinal stability.
Your surgeon will then close the incision, which typically leaves behind only a small scar or scars.
Generally the patients can go home within 3-5 days after traditional PLIF and within 1-2 days after a minimally invasive PLIF. The patients are advised on wound care and how to perform their daily activities like getting up from bed, sitting, standing, walking and lifting by a physical therapist before they are discharged. Certain exercises to improve the strength and endurance of the back muscles are taught to the patient. Patients aregenerally not required to wear a back brace after surgery. Patients resume light work within 2-3 weeks following surgery and recreational sports within 3 months of surgery.
Hello, my name is Lawrence and I chose India for my liberation because of the price of the procedure. The Treatment Assistance II was given all my MRI’s, diagnostic test results and everything pertaining to my procedure to take home. If you take someone with you they stay in the same hospital room with you. I went alone but my friend’s husband was there with her and he said this saved money. I did some sightseeing and souvenir shopping while at the hotel.
The hospital was great, new, clean, fantastic patient care. They also have tight security at the hospital; you are picked up and dropped off at the airport.
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