Spondylodesis is a surgical procedure in which one or more vertebral bodies are stiffened in order to improve or restore the stability of the spine. Spondylodesis is a treatment procedurewith very few complications. The operation is usually followed by a stay in hospital lasting several days.
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Spondylodesis is used to treat instability of the spine.
The aim of spondylodesis is to stabilize the unstable spinal segment by stiffening it and returning it to its original position. Spondylodesis also aims to free and relieve nerve tracts trapped in the spinal canal.
Slipped vertebrae - also known as spondylolisthesis - is an instability of the spine. Congenital malformations or signs of wear and tear in a vertebral body segment lead to a loosening of the structures that connect the vertebral bodies. These include
The result is a displacement of the vertebral bodies in relation to each other, with one vertebra slipping forward over the vertebral body below it.
The main symptoms of spondylolisthesis include pain in the back, particularly in the lumbar spine, and pain in the legs.
This mainly occurs during physical exertion and is dependent on posture. The back and leg pain worsens when walking, standing or sitting and subsides when lying flat.
If the spondylolisthesis pinches the nerve tracts in the spinal canal, sensory disturbances and sometimes paralysis of the legs can also occur.
Before spinal fusion surgery is performed, a detailed medical history and neurological examination must be carried out to determine the cause of the symptoms.
In order to make a diagnosis and plan treatment, an X-ray of the spine should be taken. Imaging examinations such as magnetic resonance imaging(MRI) and computer tomography can also be used to assess the bony structures and changes in the spine.
A spondylodesis is usually performed by a specialist in neurosurgery, orthopaedics or trauma surgery.
There is no real alternative to spinal fusion surgery using spondylodesis.
Before spondylodesis is performed to treat spondylolisthesis, conservative therapeutic measures such as
are used to combat the back and leg pain. However, the actual cause of the pain, i.e. spondylolisthesis caused by congenital deformities or wear and tear, cannot be eliminated in this way.
Surgical fusion of the spine by means of spondylodesis is necessary if the patient suffers from severe spondylolisthesis with severe instability of the spine and, despite intensive conservative treatment with physiotherapy and pain medication, continues to suffer from severe, unbearable back and leg pain.
Especially if the patient also suffers from numbness and paralysis and is severely restricted in their everyday life and mobility, surgical fusion of the spine by means of spondylodesis is the only effective and permanent treatment.
Spondylodesis will always be necessary sooner or later!
Various surgical techniques are available for spondylodesis. Spondylodesis can be performed using open surgery via a larger incision, but in some cases it can also be performed using a minimally invasive procedure.
On the other hand, the spine can be accessed from the back (dorsal), from the front through the abdominal cavity (ventral), combined from the front and back (dorsoventral) or from the side (TLIF procedure). In most cases, however, the posterior approach is preferred. In addition, the procedure is always performed using a surgical microscope.
Spondylodesis is performed as an inpatient procedure under general anesthesia. General anesthesia is induced immediately before the operation and maintained for the entire duration of the surgical procedure. The operation takes a total of 3 to 4 hours. Afterwards, the patient is monitored in the recovery room until the effects of the anesthesia wear off.
During open spondylodesis surgery, the patient lies on their stomach with pillows under their pelvis and chest. At the beginning of the spondylodesis procedure, the neurosurgeon makes a skin incision about ten centimetres long over the affected section of the spine. He then carefully detaches the back muscles from the vertebral bodies in order to obtain a clear view of the spinal section to be operated on.
Using the surgical microscope, the neurosurgeon then opens the spinal canal and gradually removes the entire intervertebral disc from the constricted intervertebral space.
In the further course of the surgical stiffening of the spine by means of spondylodesis, the neurosurgeon pulls the slipped vertebra back into the correct position and inserts a disc replacement into the resulting cavity between the vertebral bodies. These disc replacements are implants made of either carbon, plastic or titanium filled with the body's own bone tissue and bone replacement material.
In order to stiffen the spine and ensure that the vertebral bodies grow together at the correct distance and in the correct position , the neurosurgeon then fixes the two vertebral bodies with rods, metal plates and screws. To do this, he turns titanium screws into the two vertebral bodies to be fused and connects them longitudinally with rods or metal plates.
From Weiss HR, Goodall D - Weiss HR, Goodall D. Scoliosis. 2008 Aug 5;3:9. PMID: 18681956. doi:10.1186/1748-7161-3-9., CC BY 2.0, Link
Complications and risks are rare. As with all major operations, there may be
can occur. In addition, complications related to the implant or the screws should also be mentioned. For example, the screws or implant may be positioned incorrectly or the screws may become loose, which may necessitate a second operation to correct them.
In addition, in rare cases, the nerve skin or individual nerves may be injured, resulting in paralysis, impaired sensation and movement or pain.
If the approach is made from the front or the side, injuries to the organs and vessels in the abdominal cavity are also possible.
Spondylodesis surgery is usually followed by a hospital stay of 5 to 6 days. Although mobility is only slightly restricted after discharge from hospital, heavy back strain should be avoided for the first 4 to 6 weeks after the operation.
Approximately 6 weeks after the operation, outpatient follow-up treatment in the form of physiotherapy can be started to strengthen the abdominal and back muscles.
A material check of the inserted implant and the screws and rods by means of X-ray examination should be carried out after about six to nine months.
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