Is Spinal Fusion Surgery Always Recommended For Back Pain?

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  • 23 May, 2018

An individual experiences back pain when there is an insult to the muscles, ligaments, or tendons. Inappropriate body posture, lifting of heavy objects more than the sustainable ability of the body, fractures, and lack of exercising or excessive exercising are some of the common causes of back pain, which mostly affects the region of the lower spine.

Commonly, back pain may go off with physiotherapy, heat therapy, acupuncture, and spinal manipulation combined with pharmacological agents such as muscle relaxants and painkillers within 4 to 5 weeks. But certain cases may require surgical intervention.

This article talks about some of the common reasons why people may experience back pain. Additionally, it examines what exactly is spinal fusion surgery and when are people recommended to undergo it.

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Major Reasons For Back Pain

Back pain can result in any part of the spine, including the cervical, thoracic, lumbar, and sacral vertebrae. Back pain can be of various types such as pathologic, physiological, or mechanical. Risk factors may include obesity, sedentary lifestyle, and weight gain during pregnancy, poor body posture, lack of regular fitness regime and smoking.

The most common region of back pain is the lower back as most of the body weight is amassed there. Moreover, maximum movement of the spine occurs in the lower back and therefore, lower back pain is the most prevalent health ailment affecting the population in the developed nations.

Due to lifestyle factors, injury, or other factors, people may develop spine-related conditions such as spinal stenosis, disc herniation, slip disc, and nerve compression. These conditions also cause a peculiar pain in the back, which sometimes radiates down the legs and hence, restricts movement and affect the daily routine.

Conservative Treatment vs. Surgery

Lower back pain may result in prolonged suffering and not every individual with spinal pain can be treated conservatively. There are multiple anatomical sources of lower back pain and virtually there are no standard methods of categorizing the pain except with the help of specialized radio-diagnostic techniques.

Patients who cannot be treated conservatively are indicated for surgical intervention to restore their quality of life. Individuals with severe spinal conditions such as sciatica, spondylolysis, spinal stenosis, and degenerative disc disease are often recommended to go for a surgery for instant and long-term relief, among other benefits.

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Spinal Fusion Surgery

Spinal fusion is one such surgery that helps treat a variety of conditions. Spinal fusion is similar to the welding process, which is done to make a single solid entity. This surgery is recommended for individuals who experience pain due to friction between the vertebrae or accidental tapping or compression of the nerve root while moving.

During this procedure, two or three vertebrae are fused together to form a single, solid bone. This eradicates the motion between the vertebrae, prevents nerve compression, and reduces pressure on the surrounding ligament structure.

Indications For Spinal Fusion Surgery

Spinal fusion surgeries are indicated in several conditions, including emergency situations. Some of the scenarios that may indicate the need for a spinal fusion surgery include the following:

  • Trauma
  • Tumour or infections
  • Flat-back syndrome
  • Pseudo arthritis
  • Adjacent segment degeneration
  • Spinal deformity
  • Spondylolisthesis
  • Spondylolysis
  • Recurrent disc herniation
  • Spinal stenosis
  • Facet syndrome
  • Degenerative disc disease in elderly or degenerative disc disease at multiple levels
  • Patients not responding to conservative treatment even after three months of continuous use

A spinal fusion surgery should not be the first line of treatment in the case of pure stenosis, initial disc herniation, and chronic lower back pain without any clear focus on radio imaging techniques such as X-rays, computed tomography (CT) and magnetic resonance imaging (MRI). The decision to conduct a surgery should be based on the magnitude of the deformity.

A patient should be screened thoroughly for non-operative treatment before being considered as a potential subject for the spinal fusion surgery. A structured non-surgical symptomatic management of the condition is recommended for at least six months in continuity before advising a spinal surgery.

However, that does not mean that the rule remains the same for all patients. In some cases, spinal fusion is conducted as an emergency procedure for better long-term outcomes. The decision to conduct spinal fusion as an emergency procedure lies with the surgeon handling the case.

Therefore, for patients, it is always better to go with the judgment of the doctor, especially when there is an emergency. In the case of non-emergency situations, a patient can take a second opinion to be sure about the doctor’s recommendation and their own decision about undergoing the surgery.

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Spinal Fusion Level I, II, and III

People are often confused when it comes to multilevel spinal fusion. As a general rule, the lumbar spinal fusion surgery is considered to be the most effective for conditions that affect just one level of the spine. This is what usually happens in a majority of the cases. One-level spinal fusion is not likely to cause any restrictions with respect to the motion.

However, some cases may be managed with the help of two-level spinal fusion or three-level spinal fusion. Spinal fusion Level II is considered reasonable for cases required extensive relief in pain. In this case, the motion of the spine is somewhat affected but the pain is relieved.

Some individuals suffering from scoliosis or lumbar deformity may be recommended spinal fusion Level III. The three-level spinal fusion, however, is unlikely to provide relief from the pain because the normal motion in the lower back is severely affected in such cases. This results in excessive pressure on the remaining joints.

Spinal Fusion Surgical Techniques

There are different surgical techniques and approaches that are used to conduct spinal fusion. Some of these include the following:

  • Posterolateral gutter fusion
  • Anterior/posterior spinal fusion
  • Anterior lumbar interbody fusion (ALIF)
  • Transforaminal lumbar interbody fusion (TLIF)
  • Posterior lumbar interbody fusion (PLIF)
  • Extreme lateral interbody fusion (XLIF)

The spinal fusion success rates depend on a number of factors, including correct diagnosis, the experience and skills of the surgeon, patient’s condition, and the pre-operative lifestyle of the patient. It is important for people undergoing spinal fusion to stay motivated for rehabilitation and proper restoration of their functional ability.

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