Spinal Instrumentation and Fusion
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.
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.
This article is an excerpt from the book Save Your Aching Back and Neck: A Patient’s Guide, edited by Dr. Stewart Eidelson.