Spinal Fusion in Iran

Preparation before surgery may involve trimming hair over the surgical site and cleaning the area with a special soap or antiseptic. Additionally, the surgical team may order monitoring of any unhealthy bacteria in your nose by taking a swab sample.

Typically, the preparation for spinal fusion is like other surgical procedures. It requires preoperative laboratory testing.

Before spinal fusion, you should tell your physician about any of the following:

. Cigarette smoking, which may reduce your ability to heal from spinal fusion

. Alcohol use

. Any illnesses you have, including colds, the flu, or herpes

. Any prescription or over-the-counter medications you’re taking, including herbs and supplements.

You’ll want to discuss how the medications you’re taking should be used before and after the procedure. Your doctor may provide special instructions if you’re taking medications that could affect blood clotting. These include anticoagulants (blood thinners), such as warfarin, and nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin and ibuprofen.

You’ll be given general anesthesia, so you’ll need to fast for at least eight hours before your procedure. On the day of surgery, use only a sip of water to take any medications your physician has recommended.

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When to consider a Spinal Fusion Procedure

Who is a good candidate for spinal fusion?

You may want to consider a spinal fusion procedure if your back or neck pain is severe, and pain and loss of function is diminishing your quality of life.

Your doctor may decide that you are a good candidate for spinal fusion surgery if:

. Your pain is chronic.

. Your spine condition only affects one or two discs or vertebrae.

. Nonsurgical management like physical therapy, nonsteroidal anti-inflammatory medications, or back bracing hasn’t worked.

If you decide on surgery, ask if you are a good candidate for minimally invasive surgery. It can involve a faster recovery and less pain than open surgery.

Who is not a good candidate for spinal fusion?

You may not be a good candidate if:

. You have been having back or neck pain or symptoms for less than six months.

. Your spine condition affects discs or vertebrae at multiple levels of your spine. Treating multilevel disease with spinal fusion can result in losing too much spine flexibility.

. You have a severe illness or infection.

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Risks and Complications

As with any surgery, there are risks associated with spinal fusion. Your doctor will discuss each of the risks with you before your procedure and will take specific measures to help avoid potential complications.

Potential risks and complication of spinal fusion include:

. Infection. Antibiotics are regularly given to the patient before, during, and often after surgery to lessen the risk of infections.

. Bleeding. A certain amount of bleeding is expected, but this is not typically significant. It is not usually necessary to donate blood before spinal fusion.

. Pain at graft site. A small percentage of patients will experience persistent pain at the bone graft site.

. Recurring symptoms. Some patients may experience a recurrence of their original symptoms. There are various causes for this. If your original symptoms recur, inform your doctor so that he or she can determine what is causing your symptoms.

. Pseudarthrosis. This is a condition in which there is not enough bone formation. Patients who smoke are more likely to develop a pseudarthrosis. Other causes include diabetes and older age. Moving too soon—before the bone is able to start fusing—may also result in a pseudarthrosis. If this occurs, a second surgery may be needed in order to obtain a solid fusion.

. Nerve damage. It is possible that nerves or blood vessels may be injured during these operations. These complications are very rare.

. Blood clots. Another uncommon complication is the formation of blood clots in the legs. These pose significant danger if they break off and travel to the lungs.

. Donor bone graft complications like tissue rejection.

. Respiratory problems

. Heart attack or stroke during surgery

. Inadequate wound healing

. Reactions to medications or anesthesia

. Additional stress on the bones adjacent to the fused vertebrae

The most serious complications are blood clots and infection, which are most likely to occur during the first weeks following surgery.

The hardware will need to be removed if it’s producing pain or discomfort.

Contact your doctor or seek emergency help if you experience any of these symptoms of a blood clot:

. A calf, ankle, or foot that suddenly swells

. Redness or tenderness above or below the knee

. Calf pain

. Groin pain

. Shortness of breath

Contact your physician or seek emergency help if you experience any of the following symptoms of infection:

. Swelling or redness at the edges of the wound

. Drainage of blood, pus, or other liquid from the wound

. Fever or chills or elevated temperature over 100 degrees

. Shaking

During Spinal Fusion Surgery

During spinal fusion

Surgeons perform spinal fusion while you’re under general anesthesia so you’re unconscious during the procedure. Surgeons have developed a variety of techniques for performing spinal fusion surgery. The technique your surgeon uses depends on the location of the vertebrae to be fused, the reason for the spinal fusion, and in some instances, your general health and body shape.

Generally, the procedure involves the following:

. Incision. To gain access to the vertebrae being fused, the surgeon makes an incision in one of three locations: in your neck or back directly over your spine, on either side of your spine, or in your abdomen or throat so that your surgeon can access the spine from the front.

. Bone graft preparation. The bone grafts that actually fuse two vertebrae together may come from a bone bank or from your own body, usually from your pelvis or hip. If your own bone is used, the surgeon makes an incision above your pelvic bone, removes a small portion of it and then closes the incision. Bone from another person is called a donor graft.

. Fusion. To fuse the vertebrae together permanently, the surgeon places the bone graft material between the vertebrae. Metal plates, screws or rods may be used to help hold the vertebrae together while the bone graft heals.

In selected cases, some surgeons use a synthetic substance instead of bone grafts. These synthetic substances help promote bone growth and speed the fusion of the vertebrae.

Are there other treatment options before having spinal fusion surgery?

In most cases, doctors recommend less invasive treatments to restore spine function and reduce pain. Less invasive treatments include rest, physical therapy (exercises and stretches for the back), back braces, and medications.

Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on spinal fusion surgery.

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After Spinal Fusion Surgery

Recovery

Spinal fusion recovery can take weeks or months, depending on the extent of the surgery, your age, and your overall health condition. Here’s what you need to know about recovery after spinal fusion surgery.

. Pain Control after Spinal Fusion

Your pain level may vary, depending on the location of the spinal fusion. Many people who undergo cervical spinal fusion, for example, report very little pain afterwards. In fact, their previous neck pain often disappears immediately. If you have a lumbar spinal fusion performed, you may experience more discomfort.

Young adults undergoing spinal fusion for scoliosis likely can expect significant discomfort immediately following surgery, as these procedures often are extensive and involve the placement of many instruments, including metal rods and screws.

Your surgeon can provide you with multiple strategies for managing your post-surgical pain. These approaches may include:

. Intravenous pain medication while hospitalized

. Oral pain medications prescribed to take after you get home

. Pain “ball” or pump, a disposable device worn on the outside of the body that slowly infuses pain medication to the surgical site through a flexible plastic line that enters the body through the incision.

You should take all oral medications as directed and safely dispose of any unused narcotics. The pain ball will slowly deflate as the medication enters your body, and your doctor will remove it during a follow-up appointment.

You should not take over-the-counter non-steroidal anti-inflammatory (NSAID) medications for your post-fusion pain unless your surgeon explicitly tells you to do so. These products can interfere with the bone graft process.

. Incision Care after Spinal Fusion Surgery

Depending on the type of surgery you had, your incision may be large or tiny. The size of the incision will determine the prominence of the spinal fusion scar. If the appearance of your scar is a concern, discuss this with your surgeon in advance of the surgery.

To care for your incision after spinal fusion, follow your surgeon’s written instructions. Typically, to care for an incision you should:

. Allow any steristrips (small adhesive tapes across the incision) to fall off on their own, or gently remove them after about 10 days.

. Avoid soaking in water, such as a bathtub, hot tub, or swimming pool.

. Gently clean the incision as directed with mild soap and water, patting dry afterwards.

. Watch for signs of infection, such as a fever, spreading redness and warmth over the incision, and oozing greenish or foul-smelling pus.

As long as you follow your written post-op instructions, your incision likely will heal just fine. Call your surgeon’s office if you have any questions or concerns.

. Prepare for Post-Fusion Bracing

Whether you have spinal fusion surgery in the neck or the lower back, you’ll likely be fitted with a brace that restricts your movement. This restriction allows the bone graft to heal without disruption or displacement. These braces often must be worn 24 hours a day, including during sleep and showering.

After cervical spinal fusion, you likely will wake up wearing a rigid neck brace, sometimes referred to as a “Miami J” collar. Later, your doctor may replace the rigid brace with a soft collar that can be taken off for showering and certain other activities.

After lumbar spinal fusion, you may be given a girdle-type brace that wraps tightly around your lower back and midsection. Your doctor will tell you how often to wear this brace.

If you’ve had spinal fusion surgery for scoliosis, you may wake up in a rigid brace that encloses your entire torso.

Be sure to go over the bracing instructions with your surgeon or nurse. You should not remove the brace under any circumstances, unless your doctor tells you to. Removing the brace prematurely can cause serious post-surgical complications.

. Activity Restrictions after Spinal Fusion Surgery

Your post-operative instructions should detail exactly what types of activities you can continue to engage in. These activity restrictions will differ, depending on the location of the surgery. In general, after spinal fusion surgery you should:

. Avoid bending or twisting motions at the level of the surgery.

. Avoid lifting and carrying objects that exceed the weight limitation issued by your surgeon.

. Avoid sexual activity until cleared by your doctor.

. Avoid stairs until cleared by your doctor.

. Avoid strenuous activities of any kind (golfing, tennis, home improvement tasks, etc.).

. Walk frequently, to the limit prescribed by your surgeon.

. Wear your brace as instructed.

If you follow all your surgeon’s instructions, you can expect a smooth spinal fusion recovery that relieves your back pain and any previous numbness or tingling. Many people find that spinal fusion restores their quality of life and allows them to resume their previously active lifestyle, once the fusion has healed.

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Results

Spinal fusion is typically an effective treatment for fractures, deformities or instability in the spine. But study results are more mixed when the cause of the back or neck pain is unclear. In many cases, spinal fusion is no more effective than nonsurgical treatments for nonspecific back pain.

It can be difficult to be certain about what exactly is causing your back pain, even if a herniated disk or bone spurs show up on your X-rays. Many people have X-ray evidence of back issues that have never caused them any pain. So your pain might not be associated with whatever problem has been revealed on your imaging scans.

Even when spinal fusion provides symptom relief, it does not prevent you from developing more back pain in the future. Most of the degenerative conditions in the spine are caused by arthritis, and surgery will not cure your body of that disease.

Immobilizing a section of your spine places additional stress and strain on the areas around the fused portion. This may increase the rate at which those areas of your spine degenerate — so you may need additional spinal surgery in the future.