One of the more common surgical interventions for people with a certain severity of low back pain is called an intervertebral (spinal) fusion.
According to the American Academy of Orthopedic Surgeons: “Spinal fusion is a surgical procedure used to correct problems with the small bones in the spine (vertebrae). It is essentially a “welding” process. The basic idea is to fuse together two or more vertebrae so that they heal into a single, solid bone. This is done to eliminate painful motion or to restore stability to the spine.”
To learn more about this type of surgery, I spoke to Dr. Tony Bozzio.
Dr. Bozzio is an orthopedic surgeon at Bay Street Orthopedics and sees patients in Petoskey, Charlevoix, Gaylord, St. Ignace and Traverse City.
What type of patient do you usually recommend an intervertebral fusion to?
Bozzio: “In general, patients who undergo common lumbar fusions have either a form of instability which is called spondylolisthesis where one vertebral body slides forward on another creating pain in both the back and legs, or severe narrowing in locations where the nerves cannot be decompressed without removing a significant amount of bone. When this bone is removed, a fusion is planned.”
Intervertebral fusion isn’t a new procedure, but have there been any recent innovations in the operative technique?
Bozzio: “Yes. Over the years that has been an increasing trend towards minimally invasive surgery. These techniques continue to evolve with advances in both technology and biologics which are the bone grafts and bone graft substitutes used to help achieve a solid fusion.
“There are many ways to fuse the spine in terms of technique and approach to the spine, but with the newest techniques I have seen a significant benefit for patients who undergo minimally invasive transforaminal lumbar interbody fusion, or MIS TLIF for short. This has been due to improved retractor systems that limit the size of the incisions and allow for the use of an ultrasonic bone scalpel that is used to remove bone in order to decompress the nerves.
“Another huge step has been the use of better bone graft products that have been refined and processed differently to get the highest fusion rates in combination with expandable cages or spacers with novel surface technologies that attract bone. These go into the disc space, and then based on preoperative planning, are customized for the patient to restore normal disc height and alignment.”
What benefits from these innovations will patients experience?
Bozzio: “I have seen significantly shorter surgical times which means less anesthesia time for the patient, less blood loss, faster recovery, and a move towards outpatient surgery.”
Do all spine surgeons use this technique?
Bozzio: “There are surgeons who do MIS TLIF and it can be a great operation. I think that the retractor system I have in combination with the ultrasonic bone scalpel is a giant step forward in the progression of MIS TLIF. I think it allows for better visualization, better correction of disc height and alignment, less time under anesthesia for the patient, and I think there will be better long term outcomes and a lower rate of reoperation or adjacent level disease.”
What can patients do to maximize their outcome after surgery?
Bozzio: “For the first few weeks after surgery, I tell patients not to overdo it. With less postoperative pain and minimal pain medication use, there is a tendency to get back into daily activities quickly. The incisions need to heal and so the therapy at that point is daily walking and gentle stretching. After two to three weeks we start physical therapy that is initially geared towards tissue healing and then transition into stretching and gentle core strengthening.”
Here are a few things you can do for any type of back pain, regardless of whether you’ve had surgery, plan to have surgery in the future, or just want to get rid of day-to-day aches and pains:
See a physical therapist first
We’re specialists in human movement. While exercise is good for nearly all types of back pain, certain types of exercise can be detrimental to certain spine conditions. A specialist can help you match the right type of exercise to your individual issues.
Research has long supported general exercise as a means of reducing pain and improving mobility in nearly all conditions which cause pain. If you’ve been sedentary, committing to a 30 minutes daily walk is a great place to start. Other forms of general exercise can be biking, hiking, or a gym-based exercise regimen that works the entire body. Before you start that last one, see the suggestion above.
Knowledge is power. In cases of pain that has been present for at least a few months, most people report a significant amount of fear surrounding their condition. They worry that certain activities might cause even more pain or may injure them further, so they (understandably) decide to lay low. Unfortunately, this often creates a cycle in which more pain leads to less movement, which causes more pain, which leads to less movement, and so on and so on.
That last item can’t be understated. Many times when I meet for the first time with patients experiencing pain, we spend most of the session just reviewing the source of their pain and learning what it is ok to push through and what isn’t.
If patients leave that first session with a decent understanding of why they hurt and what they can still do safely, we’ve set ourselves up for success down the road.