If you’re a “just the facts” kind of person, here’s a fact you might be interested in: Spinal surgery is only between 50% and 70% effective, compared to the 90+% positive outcomes for hip and knee surgeries, where joint replacement is common. This means there’s still quite a long way to go when it comes to innovation for the spine patient suffering from back and leg pain.
Spinal fusion success rates, in particular, remain low due to a number of obstacles posed by the procedure itself. Studies have shown that fusion patients are 2-5 times more likely to undergo multiple surgeries compared to patients receiving spinal joint replacements. As time goes on, it’s becoming increasingly clear that, for the spinal fusion patient, your first surgery is not likely to be your last.
Why? What prevents fusion surgery from being more successful? Let’s take a closer look at the spinal fusion procedure and some issues to understand if you’re considering one.
The Spinal Fusion Procedure
Your spine is a stack of bony vertebrae all connected together. Discs provide cushioning and movement between each vertebral body, and facet joints at each level of your spine control excess movement. During fusion, a surgeon removes the disc material and all or part of the facet joints, packs the space with bone graft, and then inserts spacers, screws, and rods into the bones to temporarily hold everything in place. Eventually the bone graft fuses, the body heals, and what were once two separate vertebrae are now joined as one solid mass of bone. Some patients require multi-level fusion, which means fusing more than two vertebrae. There are lots of different approaches and techniques (ALIF, TLIF, PLIF, OLIF, XLIF, etc.) but they all essentially boil down to this—take multiple bones of the back and fuse them into one big chunk.
Spinal Fusion Precautions
The spine is a joint just like any other joint in your body, so if you fuse it, you lose mobility. You could argue there are lots of joints in the spine (unlike your hip, for instance, that has just one), so what’s the big deal? Why can’t the other joints compensate for the one that was fused? To some degree, that’s true: A single-level fusion may not reduce your range of motion too much. In fact, you might not even notice it.
But there’s more to it than that. Fusing even a single level of the spine changes the environment of that level, which is likely to cause problems down the line. In fact, the real challenges associated with spinal fusion typically develop several months to several years after surgery.
Accelerated Degeneration Of The Spine
It you take away of the function of one or more levels with fusion, all of the stress caused by your daily movements is transferred to the levels above and below the fused location, creating a heavy burden on these adjacent levels. For many patients, the adjacent levels may be somewhat compromised already (i.e., already partially affected by disease), and their degeneration can be rapidly accelerated. Recent research has shown that even healthy adjacent levels can be negatively impacted as a result of the transference, simply because you’re requiring the spine to work harder and outside its normal range of motion. The likelihood of needing future surgery increases as a result.
Looking for an alternative to spinal fusion? Find out more about BalancedBack™ Total Joint Replacement.
It wasn’t until fairly recently that we began to appreciate the foundational role that every level of the spine plays in posture. In the past, surgeons would fuse levels relatively flat with little to no regard for lumbar lordosis (the natural curve of the spine). Now we realize that correcting lumbar lordosis is the difference between a patient being able to stand upright comfortably vs. constantly fighting to maintain balance. If a patient is fused in an incorrect posture, their muscles work overtime to manage the load, usually resulting in painful spasms and continued back pain. Many surgeons learned to avoid “flat back syndrome” by adding lordosis to even single-level fusions.
But now we are learning that even these “modern” fusions cause problems. These lordotic fusions may even be worse than the flat back. Why? You stand in lordosis and sit in flexion. When you sit, your spine naturally gives back the lordosis and flexes forward. A flat back can be miserable for standing, but might feel great sitting. A lordotic back can be great for standing, but very damaging to the adjacent levels when sitting.
So, if you’re fused in a standing position, then your seated position is unnatural. Most of us sit at work, in the car, and in front of the TV. It’s pretty easy to see the dilemma—there really is no such thing as a good or “modern” fusion.
A Spinal Fusion Alternative
Today, thanks to an innovative new procedure, many people with back pain have another option: BalancedBack™ Total Joint Replacement. Preserving mobility of the spine is critical to maintaining health and stability. BalancedBack™ replaces the functions of both the damaged disc as well as the facets, adding stability after the surgical procedure just like a fusion. But unlike fusion, BalancedBack™ addresses the root cause of your back and leg pain while maintaining mobility and, as a result, the natural balance of your spine. You can stand in lordosis, sit in flexion, and sleep in between. Because BalancedBack™ moves with you, the levels above and below move naturally too.
No matter how good the fusion, it’s still a fusion. And that’s a fact.
If you’d like to find out more about the BalancedBack™ Total Joint Replacement procedure, visit our website or schedule a complimentary call with our clinical coordinator.