Lumbar spinal fusion
definition
The Spinal fusion (Blocking, tensioning) refers to a partial, artificially induced by surgery stiffening of the Lumbar spine (Lumbar spine). Such stiffening can be seen as a last resort in the case of extremely persistent and unbearable back pain.
This can happen with injuries to the lumbar spine, but also with inflammation or deformation of the spine (Scoliosis) be the case. It is hoped that the stiffening will remove movement-dependent pain. The intervention is permanent.
The spondylodesis of the lumbar spine is a complex and risky operation! Hence, a long and detailed one consultation, as well as a thorough and lasting check before the procedure is essential.
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Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
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The spine is difficult to treat. On the one hand it is exposed to high mechanical loads, on the other hand it has great mobility.
The treatment of the spine (e.g. herniated disc, facet syndrome, foramen stenosis, etc.) therefore requires a lot of experience.
I focus on a wide variety of diseases of the spine.
The aim of any treatment is treatment without surgery.
Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.
You can find me in:
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Kaiserstrasse 14
60311 Frankfurt am Main
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Further information about myself can be found at Dr. Nicolas Gumpert
General
The lumbar region belonging to the lumbar region Spine usually consists of 5 free Lumbar vertebrae (L1-L5), which via cartilaginous intervertebral discs, the so-called. Band washers are connected to each other.
Each vertebral body also has 4 small articular surfaces, which form individual joints with the upper or lower lumbar vertebrae, which as a whole are responsible for the agility the lumbar spine are responsible.
Of the Vertebral arch forms the rear (dorsal) part of the Vortex, and together with the vertebral body forms the Vertebral hole. All vortex holes together form the Spinal canalthrough which the Spinal cord pulls.
In the side area in the lumbar spine you can find the Costal processes, on the vertebral arches are backward Spinous processes. A movement segment is understood to mean 2 adjacent vertebral bodies, which are connected to one another by the intervertebral disc and the vertebral joints.
The lumbar spine carries the Main burden of the body and is subjected to the greatest static and mechanical load. This section of the spine is particularly prone to injuries and signs of wear and tear! It is therefore not surprising that the most common are the motion segments L4-L5 and L5-S1 be stiffened!
indication
With some diseases, a stiffening the lumbar spine by Spinal fusion be suitable to eliminate instabilities that have arisen. A lack of stability in the movement segments can have various causes, the most common of which are:
1) Disc diseases caused by wear and tear (Osteochondrosis)
Age-related but also stress-related, the ability of the decreases Intervertebral disc as ,buffer‘Or 'shock absorber' to act. This increases the load on the vertebral bodies and instabilities arise.
2) Spondylolisthesis
In this clinical picture, the spine slides forward (ventrally) compared to the vertebral body below.Often one finds this phenomenon in younger people and goes with a significant one Pain burden hand in hand as the sliding Vertebral bodies can irritate exiting nerves.
3) Spinal stenosis of the lumbar spine
Lumbar spinal stenosis is a change or change. Narrowing of the spinal canalso that the nerves passing through can be irritated or damaged. The disease can be acquired or congenital.
4) Vertebral fracture (Fracture)
Complicated fractures involving the vertebral canal can cause a Spinal fusion Show. If there is a risk of injuring or crushing the spinal cord, stiffening is the method of choice.
5) Spondylitis (Infection of the Vertebral bodies)
In many cases, inflammation of the vertebral bodies can be avoided with a suitable one antibiotic therapy. However, if there is a risk of the infection spreading to the central nervous system, it can block the affected area Lumbar vertebrae be the last resort.
6) Vertebral body tumor
Tumors, whether benign or malignant, can die Bone strength greatly reduce. This creates instabilities that can be eliminated by a spinal fusion.
7) Scoliosis
deformity of the Lumbar spine
requirements
The stiffening only has a chance of success if that Cause of pain with absolute certainty on one or more Vertebral bodies can be narrowed down. So the affected sections of the Spine specifically stiffened.
Diagnosis
To the Cause of pain There are different methods to localize it exactly. This provides the starting point for the investigations X-ray image, here e.g. Wear and tear and shifts in the whirl can be recognized well against each other.
Further methods are used for a more detailed analysis. On the one hand, this includes the Computed Tomography (CT), which shows additional cross-sectional images of the soft tissues of the Lumbar spine (lumbar spine) supplies.
E.g. too close Spinal canal (Spinal canal) can be discovered as the cause of pain. With the help of Magnetic resonance imaging of the lumbar spine (MRI of the lumbar spine) is possible without radiation exposure a change in the soft tissue (inflammation, Herniated disc of the lumbar spine etc.) in longitudinal section.
Under certain circumstances a Myelography can be used. During this imaging procedure, a contrast medium is placed in the spinal cord tube (Subarachnoid space) injected, whereby with certain questions the width of the spinal canal and the outgoing Nerve roots can be better judged.
Besides the imaging procedures there is still the option of the affected sections of the Spine to fix on trial, so to speak. Either a plaster cast, or an external support frame can be used:
Under anesthesia, four screws are put through the skin in 2 adjacent ones Vertebral bodies drilled, and then fixed together with an outer frame. If the stiffening produced on a trial basis eliminates the pain, it can be assumed that a stiffening per Spinal fusion Has success.
A good result can only be expected if, in addition to the physical diagnosis, the psyche of the back pain patient is assessed. To do this, it is necessary to discuss the motivation, Resilience as well as the Pain processing and to work out the will to recovery.
Because after a serious intervention like that Spinal fusion of the Lumbar spine there are extensive follow-up treatments (Rehabilitation clinic, physical therapy etc.) towards those affected, the course of which is central to the outcome of the operation.
method
The stiffening of the Lumbar spine by means of Spinal fusion is a complicated and time-consuming operation with different techniques and methods. For the sake of understanding, only the basic features are discussed below.
In principle, one differentiates between the Access routes (e.g. from the side) and whether neighboring Vertebral bodies braced together either from behind (dorsal), from the side (lateral) or from the front (ventral).
The different methods usually have in common that the Intervertebral disc is removed and a metallic basket, usually made of titanium, steel or carbon, is implanted.
Previously, the basket was filled with the body's own bone material, usually taken from the Iliac crest of the patient. The removal of the bone material is not inconsiderable Risks, which is why currently about possible alternatives, such as man-made bone proteins is discussed.
Through the Fixation of the movement segment to be stiffened with screws, one now hopes that during the healing process the Vertebral bodies merge together bones. This process is called bony fusion.
Complications
The Spinal fusion of the Lumbar spine is a major operation and involves risks. This includes:
Injuries to nerve roots, spinal cord sheath (dura) and Spinal cord
Paraplegia
Vascular injury, especially the aorta and Vena Cava
Infections and Wound healing disorders
Loosening, bending and breaking of screws and implants
Residual discomfort or increased pain
Pseudoarthroses
Damage and weakening of the Back muscles
Aftercare
After surgery the patients remain roughly 7-10 days in the hospital. So the risk of a thrombosis to suffer as little as possible, thrombosis prophylaxis (e.g. Heparin) administered.
To stabilize the operated Lumbar spine, can recommend a Support corset to wear Alternatively there is the possibility of one Plaster cast. If the pain allows it, you can begin to get up carefully on the first day after the operation.
Heavy lifting and carrying of loads as well as physical exercise should be avoided for about 3 months.
During the follow-up treatment is a close physiotherapeutic care very important! With the help of Back training Patients learn to strengthen their abdominal and core muscles and to avoid damaging movements. After the hospital stay, the treating orthopedic surgeon controls the healing process. Usually after a few months a X-ray image carried out for control.
