Spondylodesis – surgical spinal fusion to stabilize the spine

Spondylodesis is used to treat spinal instability. The procedure aims to stabilize the unstable segment of the spine by fusing the vertebrae and returning it to its original position.

In addition, during spondylodesis, the doctor can release and relieve pressure on pinched nerve pathways in the spinal canal. Spinal slippage (also known as spondylolisthesis) is a condition characterized by spinal instability. It results from congenital abnormalities or signs of wear and tear that cause the structures within a vertebral segment to become loose.

These include:

• Intervertebral discs
• vertebral joints, and
• ligaments

The result is a displacement of the vertebral bodies relative to one another. In this condition, one vertebra slips forward over the vertebral body below it.

The main symptoms associated with spondylolisthesis include:

• Back pain (especially in the lumbar spine)
• Pain in the legs

These symptoms occur primarily during physical activity and depend on body posture. For example, back and leg pain worsens when walking, standing, or sitting, and subsides when lying flat. If nerve pathways in the spinal canal are compressed by the spondylolisthesis, sensory disturbances and paralysis in the legs may also occur.

Before spinal fusion surgery, a detailed medical history and a neurological examination must be conducted. These examinations are intended to determine the cause of the symptoms.

To establish a diagnosis and plan treatment, the doctor should first and foremost take an X-ray of the spine.

Imaging studies (magnetic resonance imaging (MRI), computed tomography) are useful for assessing the bony structures and changes in the spine.

Spondylodesis is typically performed by a specialist in neurosurgery, orthopedics, or trauma surgery. Spinal instability is one of the most common indications for spondylodesis, a surgical procedure used in spinal surgery to stabilize the spine, in which, depending on the section of the spine, individual vertebral bodies are fused and the vertebral bodies are connected to one another.

When spondylodesis is performed, various fusion procedures—such as dorsal spondylodesis, ventral and lateral spondylodesis, or minimally invasive techniques—are used, depending on the specific spinal condition, to surgically stabilize unstable areas of the spine and correct spinal deformities.

Particularly in the lumbar or cervical spine, intervertebral discs, a herniated disc, or spinal stenosis may be the underlying causes, necessitating surgical fusion of certain segments of the spine to restore spinal stability and full load-bearing capacity.

Surgical fusion is performed either dorsally or ventrally using screws and rods or screws and plates, whereby the vertebrae are fixed to one another via the vertebral bodies using screws, so that, following postoperative care and physical therapy, pain-related movement restrictions are eliminated and symptoms such as back pain or paralysis are reduced.

If conservative therapies and treatments have not led to improvement—for example, in cases of spondylolisthesis, scoliosis and kyphosis, or neurological deficits, open spondylodesis may be necessary; in such cases, adjacent vertebral segments must be monitored long-term in addition to the fused segment, and mobilization begins as early as the first day after surgery.

There is no true alternative to surgical spinal fusion via spondylodesis. Conservative therapeutic measures may be used prior to spondylodesis to alleviate back and leg pain.

Examples of conservative treatment measures include:

• Physical therapy
• Pain medication
• Injections and
• An external support brace

However, these measures cannot eliminate the cause of the pain (congenital malformations, wear and tear).

Surgical spinal fusion via spondylodesis is necessary when:

• The patient suffers from severe spondylolisthesis with significant spinal instability.
• The patient continues to experience severe, intolerable back and leg pain despite intensive conservative therapy involving physical therapy and pain medication

If sensory disturbances and paralysis are present, or if the patient is severely limited in daily life, spondylodesis is advisable. Spondylodesis will be necessary sooner or later in any case!

Various surgical techniques are available for spondylodesis. Spondylodesis can be performed as open surgery via a larger skin incision or, in some cases, using a minimally invasive approach.

Access to the spine can be achieved as follows:

• from the back (dorsal)
• from the front through the abdomen (ventral)
• combined from the front and back (dorsoventral)
• from the side (TLIF procedure)

In most cases, doctors prefer the posterior approach. In addition, the procedure is performed using a surgical microscope. Spondylodesis is performed on an inpatient basis under general anesthesia. The patient is administered general anesthesia immediately before the surgery. Anesthesia is maintained for the entire duration of the procedure.

The surgery takes 3 to 4 hours in total. Afterward, the patient is taken to the recovery room so they can be monitored more closely until the effects of the anesthesia wear off.

The procedure is as follows:

During the open spondylodesis surgery, the patient lies on their stomach with pillows under their pelvis and chest. At the start of the procedure, the neurosurgeon makes an incision approximately ten centimeters long over the affected section of the spine.

The neurosurgeon then detaches the back muscles from the vertebral bodies to gain a clear view of the spinal segment. Using a surgical microscope, the neurosurgeon opens the spinal canal and gradually removes the entire intervertebral disc from the narrowed intervertebral space.

Next, the neurosurgeon realigns the slipped vertebra to its correct position. He then inserts a disc replacement into the resulting cavity.

The disc replacement is an implant made of carbon, plastic, or titanium, as well as the patient’s own bone tissue and bone substitute material.

 

The neurosurgeon then stabilizes the vertebral bodies to ensure the correct spacing and alignment for bone fusion. Stabilization is achieved using rods, metal plates, and screws.

To do this, he inserts titanium screws into the two vertebral bodies and connects them longitudinally with rods or metal plates.

Von Weiss HR, Goodall D - Weiss HR, Goodall D. Scoliosis. August 5, 2008;3:9. PMID: 18681956. doi:10.1186/1748-7161-3-9., CC BY 2.0, Link

The spondylodesis surgery is followed by a 5- to 6-day hospital stay. After discharge from the hospital, you will experience a slight limitation in mobility. Nevertheless, you should avoid heavy strain on your back during the first 4 to 6 weeks following the procedure.

About 6 weeks after the surgery, you can begin outpatient follow-up treatment in the form of physical therapy. This will strengthen your abdominal and back muscles.

An X-ray examination to check the condition of the implant, screws, and rods should be performed after half a year to three-quarters of a year.

What is spondylodesis?

Spondylodesis is a surgical procedure to fuse the spine, in which individual vertebrae are permanently fused together. The goal is to stabilize unstable sections of the spine and reduce back pain.

When is spondylodesis necessary?

Spondylodesis is performed when there is instability in the spine or when conservative treatments do not lead to sufficient improvement. Typical causes include spondylolisthesis, herniated discs, or degenerative changes.

How is the surgery performed?

The procedure is performed under general anesthesia and involves fixing the vertebral bodies with screws and rods. Depending on the findings, a cage may also be inserted to improve spinal stabilization.

Is mobility restricted after spondylodesis?

Because a section of the spine is fused, mobility is locally restricted. However, many patients do not view this as a disadvantage, as pain-related limitations in movement are often eliminated.

What does follow-up care involve?

After spondylodesis, targeted follow-up care with physical therapy is important to strengthen the back muscles. Full load-bearing capacity of the spine is gradually restored.