Q: Can you give an opinion about back surgery whereby a doctor would fuse the lower back using screws? At present my husband has reentered physical therapy at a local facility that uses these (unconventional?) methods that are actually starting to help him.
My husband exercises and walks. He does not smoke or drink. Do you think and when do you think back surgery should enter the picture, if ever. From my perspective, it’s hopefully never.
Thank you so very much for your time in answering my questions. The action is very helpful and comforting.
A:The purpose of spinal fusion is to connect two or more vertebrae in the spin and halt the motion between them. There are numerous approaches in which this can be accomplished. The spine is composed of 33 vertebra. At each level in the spine there is a disc space in the front and paired facet joints in the back. When considering a healthy back, this allows motion without pain but this is not the case with your husband. When fusion is accomplished, two vertebral segments get fused together to stop the motion at one of the segments. Spinal fusion involves bone grafting, essentially causing two vertebral bodies to grow together into one elongated bone. Bone graft can be taken from several areas – from the patient’s hip, from a cadaver, or it can be manufactured. During the procedure, a surgeon will place bone or bone-like synthetic material within the space between two spinal vertebrae. He or she may choose to use screws, rods, and even metal plates to hold the vertebrae together so they can heal into a solid unit. This is normal.
Spinal fusion might be recommended by a surgeon because of a fractured vertebrae, spinal weakness such as in the case of severe spinal arthritis, because of scoliosis (curvature of the spine, spondylolisthesis when one vertebra slips out of position and onto the vertebra below it, because of chronic low back pain, and because of a herniated disk. You don’t indicate the reason your husband is considering fusion and I don’t know his medical history, so I cannot project whether surgery is appropriate or not. Generally speaking, the procedure is a safe one; however, this is an invasive process and with any invasive procedure, caution must be taken. Such issues as infection, blood clots, pain and blood vessel injury must be considered as potential complications.
Because fusion is performed under general anesthesia, your husband would be unconscious during the actual surgery. The technique his surgeon uses will depend on the specific location of the vertebra to be fused and the reason the fusion is being performed. Some surgeons prefer to use synthetic substances to help promote bone growth and to speed the fusion. Your husband’s hospital stay will likely be around three days, after which he will be able to return home. He may find it necessary to wear a brace temporarily in order to maintain proper spinal alignment. He will likely undergo physical therapy and learn different methods of sitting, standing and walking.
In most instances, lumbar spinal fusion is most effective for conditions that involve only one vertebral segment and most patients are unaware of any loss of motion once a one-level spinal fusion is performed. When more than two levels of spine are considered, a reduction of pain is less likely to occur. You both should be made aware of studies with mixed comments and results. In many instances, spinal fusion has been found no more effective than undergoing non-surgical treatment when it comes to non-specific back pain. Then, when spinal fusion provides relief from the pain, it may ultimately result in more back pain in the future. Therefore, the entire process should not be entered into lightly.
You appear apprehensive and make reference to a specific physical therapy facility I have chosen to eliminate from your question. I’m somewhat confused by your statement of unconventional methods used. Don’t let your husband undergo procedures you both don’t completely understand. Educate yourselves. Ask about the pros and cons of anything and everything being done. It may be in both your best interests to request a second opinion from another surgeon if questions remain unanswered. If you do choose to proceed, be sure you have trust in the physician used.
