Spinal Fusion - Artificial Discs - BMP - Foraminotomy

Foraminotomy is a surgical procedure to treat foraminal spinal stenosis. The foramen (small passageways) created between vertebrae provides space for nerve roots to exit the spinal canal. If the foramen is clogged with debris the size of the pathway is reduced and may cause nerve compression, inflammation, and pain. In a foraminotomy the surgeon uses small tools to shave open the inside of the foramen to increase its size. When nerves have ample room, inflammation and pain are relieved.

Spinal Instrumentation and Spinal Fusion
Spinal Instrumentation is a generic term for surgical procedures that use cages, hooks, plates, rods, or screws to stabilize the spine. These devices are made of Titanium alloy and may be called spinal implants or hardware (slang). Instrumentation and fusion may help provide spinal instability and correct deformity. For example, degenerative disc disease may cause instability and progressive scoliosis may lead to deformity.

Spinal Instrumentation and Fusion

In conjunction with spinal instrumentation, bone graft is used to facilitate Spinal Fusion. Fusion occurs when bone graft grows in and around spinal implants similar to reinforced concrete. Instrumentation and fusion create a strong construct to stabilize the spine. The need to wear a brace following surgery may not be necessary. However, each patient is different and the spine surgeon will decide if a brace is necessary.

The benefits of spinal instrumentation and fusion are numerous. Some implant procedures are performed using minimally invasive techniques. Implants provide the spine immediate stability, which may allow the patient to get up the day after surgery. Before implant use, bone graft simply was not enough to support an unstable spine. The patient would be placed in a plaster cast to hold the spine still until the fusion healed.

Today patients are no longer forced to wear plaster casts following back or neck surgery. When additional spinal support is necessary the physician will prescribe a corset or removable brace (plastic and Velcro™) to restrict movement similar to a splint. Braces are worn on a short-term basis. As soon as an x-ray proves fusion has occurred, the use of the brace may be discontinued.

Instrumentation and fusion will not prohibit the patient from bending, but it will limit a portion of the spine's motion. Standing up and sitting down is seldom affected because most of this motion occurs in the hip joints. The trade-off is acceptable because, following fusion, pain from movement may be reduced or eliminated.

Bone Growth Stimulators are sometimes used in patients who are at high risk for failed fusion (diabetics, smokers). This device is placed internally complete with a battery (similar to a pacemaker) or worn externally like a belt. Stimulators emit electromagnetic waves that 'stimulate' bone tissue to heal. However, just because these devices are available does not mean that all high-risk patients are suited for fusion.

Artificial Discs
The efficacy of artificial discs is now being studied in clinical trials. There are several types being tested including composite discs made of polyethylene, hydraulic discs with a gel-like core that expands, elastic discs made with a rubber core, and mechanical discs with hinges and springs. The goal of an artificial disc is to replace a faulty intervertebral disc, which is important to the spine as a shock absorber.

Bone Morphogenetic Protein (BMP) is a genetically produced protein with the ability to stimulate a patient's own bone cells to make more bone. This development is especially important to patients who will undergo spinal instrumentation and fusion procedures in the future. BMP has been studied and shown to be safe and effective. Food and Drug Administration (FDA) approval is imminent.

Image-Guide Spine Surgery combines Computer Assisted Surgery (CAS) and the concepts of a Global Positioning System (GPS). This technology enables spine surgeons to view and navigate a patient's anatomy three-dimensionally in real time. This amazing technology allows surgeons to pre-plan spine surgery visually using a computer.

This article is an excerpt from a book titled Save Your Aching Back and Neck, A Patient's Guide (Second Edition, May 2002, completely revised).