Lumbar Spine Posterior Interbody Vertebral Fusion with bone attorney multimedia

www.medilaw.tv - Illustrates the surgical technique for performing a posterior lumbar interbody fusion. This procedure is used to remove an intervertebral disc that is causing uncontrollable pain or is compressing the adjacent spinal cord or nerve roots. Bone blocks used to replace the removed disc and maintain correct alignment. Pedicle screw instrumentation is used to ensure stability while fusion occurs. There are many different techniques to achieve the same end result, a pain-free, stable, anatomically positioned bony fusion. However, the basic procedure illustrated here is common to all posterior lumbar interbody fusions. Also shown is the patient position, skin preparation and incision, the surgical approach, the removal of the pathological intervertebral disc, the bone block insertion, the pedicle screw fusion instrumentation, x-ray position checks and finally wound closure.

 

A spinal fusion is done to join two vertebrae together to make one large bone. The surgeon roughens up the external surfaces of the two vertebrae to make the body's natural repair system think that one large bone has broken. The surgeon then adds bone to maintain and fill the gap. The body then joins the mass together, like a normal fracture. While the bone is healing, it is held still by screws and rods. Full fusion takes three months. Bone chips can be taken from your hip at the time of the operation, and then grafted onto your vertebra. Alternatively, bone can be harvested from other patients and stored until needed in a bone bank. Using bone from the bone bank saves you the pain of this surgery, but doesn't produce as high fusion rates as using your own bone. Artificial and natural bone substitutes are also available. New bone from the roughened vertebra migrates along the grafted bone to connect the area to be fused. Bone Morphogenetic Proteins may be used to accelerate the fusion rate.

 

INDICATIONS

A spinal fusion is performed when the spine is unstable, and can't maintain the functional alignment between all of its important structures, or the abnormal movements cause pain and put adjacent structures at risk of injury.

 

Causes of spinal instability include degenerative joint disease, spondylolysis, fractures, infections and tumors.

 

ALTERNATIVES

The non-surgical alternative treatments to lumbar fusion are

avoiding bending, lifting, twisting and prolonged sitting

weight loss

walking

pain-relieving medication

physical therapy

hydrotherapy.

 

The surgical alternative treatments to lumbar fusion are

injections of steroid and local anesthetic around nerves or into the facet joints

lumbar disc replacement in very few cases.

 

The use of lumbar bracing and acupuncture is controversial.

 

GOALS

The damaged, painful intervertebral disc is removed and replaced with bone. This eventually fuses the two vertebral bodies together into one solid bone.

 

TECHNIQUE

You will be placed in a kneeling position. Your skin will be cleaned. An incision will be made in the middle of the back. The overlying muscles will be moved to the sides. Your surgeon will confirm the correct vertebrae for the procedure by using x-ray imaging. The ligamentum flavum is then separated from the lamina above. The lamina above and below and the facet joints on each side are removed to make space. The remaining ligamentum flavum is removed. The disc is removed. Bone blocks are placed in the space. The tracks for the pedicle screws are prepared. The vertebra surface is roughened. The bone graft is laid. The remaining pedicle screws, brackets and rods are installed. The muscles are replaced, and the wound is closed with sutures. attorney multimedia

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