Alternatives to Spinal Fusion Surgery & Recovery

Patients with severe spinal problems are often recommended to undergo spinal surgery. This recommendation may be made for a variety of reasons, most often for lumbar spinal stenosis with spondylolisthesis, and cervical stenosis. Spinal fusion surgery can be scary for patients. Patients may ask “Is there an alternative to spinal fusion surgery?” While spinal fusion surgery may be unavoidable in many cases, our surgeons at the Texas Spine and Neurosurgery Center are among the most experienced in the state at finding ways to successfully treat patients while avoiding spinal fusion surgery. We have expertise a variety of techniques that allow us to achieve this goal. In this article, we will discuss a few of these.

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Cervical stenosis is a common reason patients are recommended to undergo spinal fusion surgery. In fact, anterior cervical discectomy and fusion (ACDF) is the most common spinal fusion surgery performed in the United States. Surgery is usually done to treat pinched nerve roots or a pinched spinal cord. However, in many cases, a fusion may not be needed or desirable. This is true especially for younger patients. In younger patients, cervical spinal fusion may be associated with accelerated degeneration of the joints above or below the fusion levels. This is known as adjacent segment disease. Adjacent segment disease can result in chronic neck pain or even new pinched nerve roots or a pinched spinal cord. It may require another fusion to treat that joint. Then the next joint may be at risk, rarely resulting in a “domino effect” in worst case situations.   Fusion may also be suboptimal in situations involving multiple joints or discs. With a multilevel fusion, there is loss of the normal biomechanics of spinal motion. This can result in loss of range of motion and chronic neck pain. Additionally, there is significantly added strain on the next joint, increasing the risk of adjacent segment disease. A younger patient with multilevel disease undergoing a multilevel fusion would be at most risk for problems in the future.

Alternative to Cervical & Lumbar Spinal Fusion Surgery

There is an old saying that goes “when all you have is a hammer, everything looks like a nail.” There are many spinal surgeons in our area who are far more comfortable performing an anterior cervical fusions than any other type of procedure in the neck. However, at the Texas Spine and Neurosurgery Center, we are highly skilled in multiple surgical techniques, including alternatives to spinal fusion, allowing us to pick the procedure that is best for that particular patient. Specifically, we are pioneers in artificial disc replacement in the neck. Our group performed the first artificial cervical disc replacement in Fort Bend County. Artificial cervical disc replacement, otherwise known as cervical disc arthroplasty, allows removal of a patient’s disc with the associated herniation, bone spurs, and decompression of the pinched nerves. However, the disc is replaced instead of the bones being fused together. This allows for continued motion at the treated level, reducing the risk of chronic pain and adjacent segment disease. This treatment is only FDA approved for single level disease and is most appropriate for younger patients.

Another excellent treatment technique we use in the cervical spine to avoid fusion is cervical laminoplasty. Laminoplasty involved reconstruction of the posterior cervical spine bones to dramatically increase the size of the spinal canal. Spinal joints are not immobilized. The spinal bones are disconnected and reconnected with a spacer to give the nerves much more room. This technique is especially useful in treating multilevel disease, especially spinal cord compression. Multilevel fusions are especially associated with loss of range of motion, chronic neck pain, and the development of adjacent level disease years after the surgery. Performing a laminoplasty can give much better short- and long-term results in some cases.

Spinal Fusion Recovery with Lumbar Spine Fusion Alternatives

Spinal fusion an also often be avoided in many patients with lumbar spinal disease. Perhaps the most common reason for patients undergoing a lumbar fusion is lumbar stenosis with degenerative spondylolisthesis. Lumbar fusion is required to restabilize the spine if open surgery is performed. This is due to the destruction of normal spinal elements in open lumbar laminectomy. The destruction of both lamina, spinous process, interspinous ligament, bilateral partial facetectomy, and the extensive stripping of muscles required in open lumbar laminectomy does weaken the spine quite a bit. However, our surgeons at the Texas Spine and Neurosurgery Center are experts in minimally invasive spinal surgery. We have published groundbreaking research on our innovative surgical techniques. Minimally invasive lumbar spinal surgery has many advantages over old-fashioned open lumbar laminectomy. In addition to smaller incisions, less blood loss, less postoperative pain, and quicker recovery, there is much less tissue destruction. Minimally invasive bilateral laminectomy can be performed with a unilateral approach. Only one spinal lamina is opened. The spinous process and interspinous ligament are left completely intact and the contralateral dorsal lamina, muscles, and facet joints are left completely intact. Therefore the spine is not destabilized. Because the spine is not destabilized, we have found that in most cases of degenerative spondylolisthesis, spinal fusion is not needed. Simple minimally invasive laminectomy alone can give our patients results at least as good as open laminectomy and fusion with much lower complication rates, much less pain, and much faster recovery. The difference for our patients is dramatic.

In conclusion, our surgeons at the Texas Spine and Neurosurgery Center in Sugar Land and the Greater Houston Area are skilled in many advanced surgical techniques that can allow patients to avoid a spinal fusion surgery. If your surgeon has recommended a spinal fusion surgery for you, please come see us first for a second opinion. It may be possible to avoid cervical or lumbar spinal fusion surgery in many cases. Contact us or reach us by phone at (281) 313-0031 for an appointment today.

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By Rajesh K. Bindal, M.D.