Alternatives to Spinal Fusion

Being diagnosed with a spine condition and then being prescribed a spinal fusion can be frightening. Spinal fusion should be the last resort after everything else has failed. Fortunately, these situations are rarer than you may think because there are various alternatives. While some patients require spinal fusion if you can avoid it by considering other options beforehand, do yourself a favor and go for it. It could turn your life around and make you a beautiful, healthy, and productive person in Los Angeles. Discussing your concerns with qualified surgeons at LAMIS Institute can help you know what to expect from various spinal fusion surgery alternatives, permitting you to weigh the advantages and disadvantages and decide based on the facts, benefits, and risks involved.

Spinal Fusion Procedure

Spinal fusion is a surgery in which at least two vertebrae are fused into one bone without a space between them. Your vertebrae are tiny, interlocking spinal bones.

In this surgery, doctors use an extra bone to fill the space between two vertebrae. When your bone heals, there is no space between them.

Typically, the surgery eliminates mobility between your treated vertebrae, making it essential for treating illnesses that make spinal movement painful. Some of these conditions include:

  • Spinal stenosis
  • Tumors
  • Herniated discs
  • Fractured vertebrae
  • Kyphosis
  • Degenerative disc disorder
  • Scoliosis (spinal curvature)
  • Kyphosis
  • Spinal instability or weakness
  • Spondylolisthesis

How the Surgical Procedure is Performed

Doctors perform this procedure in a hospital setting using general anesthesia. That means you will neither feel pain nor be conscious during the surgery.

During the surgery, you will be lying down. You will also have a heart monitor lead on the chest and a blood pressure cuff on the arm, allowing physicians to monitor your blood pressure and heartbeat during the surgical procedure.

The process involves the following steps:

  1. Incision — To access your vertebrae being fused, your skilled doctor will make an incision in either your back or neck over the spine, any side of the spine, or in the throat or abdomen.
  2. Preparing bone graft — Bone grafts that fuse two (2) vertebrae can originate from your body (usually the pelvis) or a bone bank. If your surgeon uses your bone, they will make an incision above the pelvic bone and remove a part of it before closing your incision.
  3. Fusion — To permanently fuse your vertebrae, the medical doctor will place your bone graft material between your vertebrae. They can use metal plates, rods, or screws to hold your vertebrae together until your bone graft recovers. The additional stability offered by the rods, screws, and plates helps your spine to recover with a high success rate and faster.

Sometimes, a surgeon can use a synthetic substance instead of a bone graft to promote the fusion of your vertebrae and bone growth.

Spinal Fusion Recovery

After the surgery, you will be required to remain admitted for three (3) to four (4) days. Your surgeon will be observing your reaction to surgery and anesthesia. The discharge date depends on your response to the treatment, the doctor’s practice, and your physical condition.

Before your discharge from the hospital, your surgeon will give you techniques to safely stand, sit, or walk since flexibility will be limited. They can recommend physical therapy to strengthen your back and learn different moving methods. You should put on a brace to align your spine. Additionally, it can be challenging to resume your routine until the body fuses the bone.

Risks and Complications

Common risks and complications of this procedure include the following:

  • Additional stress on the bones adjacent to your fused vertebrae
  • Infection in your wound or treated vertebrae
  • Damage to your spinal nerve, causing pain, weakness, and bladder or bowel difficulties
  • Respiratory challenges
  • Blood clots in your legs (It can be fatal if they move to your lungs)
  • Stroke or heart attack during the procedure
  • Persistent pain in your bone graft area
  • Reactions to anesthesia or medications

Sometimes fusion may not happen if there is not adequate bone formation. It requires another surgery.

The hardware used can cause residue/new leg weakness, pain, and nerve irritation.

Inflammation can result in more scarring and pain.

Since the surgery changes how your spine functions by immobilizing it, the regions below and above the surgery are at a greater risk for wear and tear. They can become painful when deteriorating, and you might experience additional challenges.

Also, being inactive, in poor physical health, or obese can increase the risk for spinal issues.

Various Spinal Fusion Surgery Alternatives

There are many alternatives to spinal fusion you can consider. They include the following:

     a) Cervical Disc Replacement Procedure

Cervical disc replacement is an excellent alternative to spinal fusion surgery; it replaces an injured disc between the vertebrae in the neck with an artificial disc. Also known as total disc replacement or anterior cervical disc arthroplasty, CDR aims to reduce pain and enhance mobility through the neck.

A disc is a gel-like cushion that reduces friction between the vertebrae. Causes of disc damage include specific health conditions, injury, or age. If your injured disc in the neck pushes on the surrounding nerves’ roots, it can result in weakness in your arms, numbness, or pain.

Ideal candidates for CDR have herniated discs causing neurological symptoms or movement difficulties. A herniated disc happens when the disc’s jelly-like core pushes through your outer layer.

You can qualify for CDR if you experience neurological signs and symptoms like numbness or weakness in your arm due to a cervical disc and you:

  • Are an adult with a developed skeleton
  • Did not give relief after six weeks of traditional treatment
  • Have at least one damaged disc between vertebrae C3 to C7

Some of the conditions that can make a patient ineligible for cervical disc replacement include:

  • Previous spinal surgery
  • Pain in the neck
  • Your discs being thinner than three millimeters
  • Serious spinal degeneration
  • Neck instability
  • Having at least two discs requiring surgery

How Cervical Disc Replacement Surgical Procedure is Done

Generally, cervical disc replacement is executed under general anesthesia, and you will not feel pain. The surgeon will insert a tube into the throat to assist you in breathing during the surgery. They will also check your heart rate, oxygen level, and blood pressure. Thanks to monitors connected to your body.

While the procedure varies with different patients, here is what to expect:

  1. During the surgery, you will lie on a table facing upward. Your surgeon will clean your skin to kill any microorganisms. They will also secure your shoulders and neck in place.
  2. The doctor will make a two-to-three-inch incision on your neck’s front or one side.
  3. They will push structures in the neck aside to access the vertebrae. The physician will remove the disc and bone spurs pressing on the nerves.
  4. The surgeon will insert an artificial disc into the neck before closing your incision using stitches. The doctor can prescribe a neck collar to prevent your head from moving.

Typically, the process takes between two and three hours.

CDR vs. Spinal Fusion

Here are reasons why CDR is an ideal alternative to fusion:

  • CDR patients are more likely to return to work sooner because they do not have to wait for bone fusion to happen like spine fusion patients.
  • The success rate of CDR is 55.2% and 60.8% for one-disc replacement and two-disc replacement, respectively. On the other hand, spinal fusion has an overall success rate of 50% for one-disc replacements and 34.2% for 2-disc replacements.
  • Unlike spinal fusion, CDR is a motion-preserving treatment option because it does not fuse two vertebrae.
  • Since CDR preserves neck motion, it exerts less stress on your vertebrae below and above the surgical level of the device, reducing the risk of spinal degenerative disc conditions in the future.
  • Cervical disc replacement patients do not wear bracing, thus promoting quick recovery.

     b) Endoscopic Lumbar Discectomy

Endoscopic lumbar discectomy is a minimally invasive alternative to fusion that removes herniated disc material from the lumbar (lower back) that is pressing on the patient’s spinal cord or nerve.

With endoscopic lumbar discectomy, the surgeon will bring you to the operative room and administer intravenous sedation. Once you are numb, your surgeon will make an incision near your herniated disc and through muscle tissue in the back. The doctor will insert a dilator to keep your incision open.

Then they will insert an endoscope into your spine. An endoscope is a tiny metal tube with a light and camera on the end that gives direct visualization through magnified video images. It also offers a passageway for the surgical tool, reducing the risk of your muscles being cut or torn.

With the guidance of the x-ray fluoroscopy and direct visualization, the doctor will remove a piece of the herniated disc using a grasper. They will then clean and treat a tiny disc bulge or annular tear utilizing a laser, killing pain nerves in your disc, hardening the disc to stop further leakage of disc material to the nearby nerves, and vaporizing disc material.

Finally, they will remove the tube and close the incision with stitches.

Some of the conditions treated by endoscopic discectomy include the following:

  • Spinal and foraminal stenosis
  • Failed back surgery syndrome
  • Sciatic pain
  • Radicular pain
  • Arthritis
  • Bone spurs
  • Spondylolisthesis
  • Bulging disc

Typically, the procedure takes approximately one hour.

While you should not feel much pain after the procedure, you may experience a minor soreness.  You do not need to worry about stitches; a bandage will cover the incision.

The time you take to recover and return to work depends on your occupation. People with sedentary jobs recover within two weeks, while athletes and those who move a lot during their regular work days may take up to six weeks to recover. Ensure you listen to your body and discuss your symptoms with your skilled surgeon before resuming your normal activities. Even if you feel okay, avoid lifting heavy objects until the doctor gives you the green light.

Lumbar endoscopic discectomy has numerous advantages over conventional spinal surgery, including:

  • It is a same-day surgical procedure
  • Preserved spinal mobility
  • Minimal blood loss
  • Small incision hence minimal scarring
  • Short recovery time

     c) Coflex Lumbar Interlaminar Device

Coflex lumbar interlaminar device is a U-shaped, robust, and flexible alloy device implanted in your spine’s back to relieve symptoms of spinal stenosis like numbness or pain in your buttocks, legs, or back. Your physician will insert the medical device between two adjacent lower back bones following surgical decompression of your affected vertebrae.

The strength and flexibility of the medical device support the spine without requiring spinal fusion surgery, maintaining the spine’s full range of motion. The device comes in five (5) sizes to suit the patient’s anatomical needs.

Before undergoing Coflex surgery, you should first determine whether you qualify. As with any surgery, you should explore all non-surgical options before considering surgery. An ideal candidate should be skeletally mature and suffering from stenosis between the L1-L5 vertebrae. The U-shaped device is intended for implantation in the spine for one- or two-level lumbar stenosis.

The Food and Drug Administration (FDA) approved procedure is performed under general anesthesia, and you will lie on your back. Your surgeon will make a tiny incision on the back where they will implant the medical device. They will implant your medical device between two (2) levels where you have disc challenges.

Guidelines for Coflex Lumbar Interlaminar Device Recovery

After the procedure, the surgeon will put you into a postoperative recovery room where the medical experts will monitor you and perform tests like checking your heart rate, respiration, and blood pressure. They can also prescribe postoperative narcotics.

Your surgeon will schedule a post-operative appointment four to six weeks after the procedure to check your recovery progress.

Some of the things you should avoid after your surgery include the following:

  • Smoking
  • Lifting heavy substances
  • Anti-inflammatory medication since they can result in bleeding and hinder your recovery process
  • Sitting for extended durations
  • Physical activities like sports

Why Coflex Surgery is a Perfect Alternative to Spinal Fusion Surgery

While spinal fusion surgery may be an ideal solution for lumbar spinal stenosis patients, it has many cons compared with Coflex surgery.

The most compelling advantage of Coflex surgery is the preservation of motion. With spinal fusion surgery, you lose the range of motion in the treated adjacent spine segments (the procedure fuses two vertebrae using screws and bone grafts to form a solid bone mass). On the other hand, Conflex surgery preserves a range of motion in your treated area. Thanks to its shape and flexibility.

Another advantage is that patients recover faster and experience relief from stenosis symptoms sooner than fusion patients.

Other advantages include the following:

  • Less hospital stays after the surgery (Most patients are discharged within 48 hours while some can return home within the same day following the surgery)
  • Less blood loss during the surgical procedure

     d) Endoscopic Rhizotomy

When a patient experiences low back pain, they consult a pain management specialist to have a medial branch nerve or facet joint injections to identify the cause of their back pain. Radiofrequency ablation (RFA) is performed percutaneously under a C-arm fluoroscopic x-ray and offers pain relief for a year. It is because the partially ablated nerves regenerate.

On the contrary, endoscopic rhizotomy significantly provides lower back pain for five years. The procedure is an excellent alternative to spinal fusion surgery for most patients.

Preparing for the Procedure

Since the doctor will administer local anesthesia, you should not eat or drink anything before the surgery. You will also require a loved one to drive you home.

Ensure you tell your surgeon about your medication and ask about which drugs you should take and should not before the surgery. Patients who take aspirin products and blood thinners should temporarily discontinue the medication before the procedure.

How is Endoscopic Rhizotomy Procedure Performed?

Your surgeon will bring you to the theater and administer local anesthesia. They will mark your surgical facet joint transverse on your skin level using fluoroscopic guidance. Then they will make a tiny incision on your skin and insert a dilator using a 0.5-inch metal cannula. Next, they will place an endoscope via the cannula and identify the medial branch nerves.

The physician uses a video camera to improve visualization. Through the endoscope, the doctor sends a tiny radiofrequency probe to the center of the endoscope to ablate and sever your medial branch nerve. Serving your nerve disconnects your pain signal, restricting your ability to feel pain from your facet joints. Next, the doctor removes the cannula and closes your incision with a stitch.

The surgeon will repeat the process at all facet joint levels on either or both sides of the lower back.

Typically, the surgical process takes an hour.

Side Effects and Complications

The procedure is safe; complications and side effects are rare.

However, you should contact your surgeon if you experience any of the following symptoms:

  • Weakness or dizziness
  • Chills, fever, vomiting, or nausea
  • Drainage, bleeding, swelling, or redness in the injection area
  • Numbness that lasts for more than three hours

Recovering from the Surgical Procedure

After rhizotomy, you can return to work and resume your normal activities the following day but should avoid lifting heavy objects. Avoid soaking yourself in a hot tub or swimming for the next 24 hours.

It is normal to experience bruising, swelling, soreness, or mild discomfort after the procedure. Over-the-counter painkillers and an ice pack can help.

     e) Intracept Procedure (Relievant)

Intracept is a spinal fusion alternative targeting your basivertebral nerve and relieves chronic vertebrogenic lower back pain.

Vertebrogenic pain is chronic low back pain caused by degenerative changes in your vertebral endplates, where your disc meets your vertebral body. The wear and tear of daily life can result in degenerative disc changes. The pain generator causing the pain is the basivertebral nerve. Other causes of chronic lower back pain include:

  • Nerves compression, injuries, and inflammation caused by infections, sciatica, and spinal stenosis
  • Traumatic injury

Eligible candidates for this FDA-approved procedure must meet the following criteria:

  • Suffering from chronic lower back pain for more than six months
  • Conservative treatment options like medication, injections, or physical therapy have not reduced the pain
  • Diagnostic imaging shows Modic changes (bone marrow lesions) in the vertebral endplates. It means inflammation and swelling irritate a nerve in the patient’s vertebra.

Here is what to expect with this minimally invasive surgical procedure:

  1. Your physician will make a three-to-five-millimeter incision in your lower back. They will place an introducer through the incision and gently drill it into the outer part of your spinal bone.
  2. Once they create a channel, they will insert a radiofrequency probe. It helps them access the center of your vertebral bone where your basivertebral nerve’s trunk is. The surgeon applies heat via the probe to desensitize the pain and prevent it from transmitting pain signals.
  3. Then the doctor will use Intracept Intraosseous Nerve Ablation System alongside radiofrequency generators to ablate basivertebral nerves of the L3 through S1 vertebrae. It relieves pain that has lasted more than six months and has failed to respond to conservative care.

The procedure takes approximately one or two hours to complete.

Notable advantages of the procedure include the following:

  • Offer treatment for persons who have not responded to traditional treatment and therapy options
  • Implant-free approach hence preserves your spine’s structure
  • Offer durable chronic lower back pain relief
  • Minimally invasive, outpatient procedure

Relievant Medsystems Company developed the procedure. The firm has sponsored three (3) clinical trials with about 400 subjects to determine the effectiveness and safety of the treatment. The research has proven a safety profile with less than 0.3% of procedure-related risks reported. Also, the studies showed improvements in pain and function three months following the procedure and can be sustained for at least five years. 

Find a Qualified Surgeon Near Me

Your physician might recommend spinal fusion surgery if you suffer from chronic back pain. However, the procedure should be your last resort. The surgery is correlated with accelerated degeneration of joints surrounding your fused vertebrae, and the fusion can result in many spinal risks, including loss of spinal mobility. Luckily, modern medical advancements have paved the way for spinal fusion surgery alternatives that offer lasting pain relief, stability, and improved quality of life. 

If you are living with neck or back pain that hinders you from participating in activities you love, call LAMIS Institute at 310-734-6088 to schedule your initial in-person consultation. Serving the Los Angeles community for many years, our seasoned team headed by Dr. Rappard can create your personalized treatment plan based on your diagnosis, needs, symptoms, and occupation. We can also help you make an informed decision so that you can return to work faster and maintain your normal spine motion and stability.

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