Spine Injury – Shiroya Orthopedic Hospital

Spinal Injury

Conditions, where spinal fusion may be considered, include the following:

Types of Spinal Fusion

There are two main types of lumbar spinal fusion, which may be used in conjunction with each other:

Posterolateral fusion: places the bone graft between the transverse processes in the back of the spine. These vertebrae are then fixed in place with screws and/or wire through the pedicles of each vertebra attaching to a metal rod on each side of the vertebrae.

Interbody fusion: places the bone graft between the vertebra in the area usually occupied by the intervertebral disc. In preparation for the spinal fusion, the disc is removed entirely, for example in ACDF. A device may be placed between the vertebra to maintain spine alignment and disc height. The intervertebral device may be made from either plastic or titanium. The fusion then occurs between the endplates of the vertebrae. Using both types of fusion is known as 360-degree fusion. Fusion rates are higher with interbody fusion. Three types of interbody fusion are:

Anterior lumbar interbody fusion (ALIF)- the disc is accessed from an anterior abdominal incision.

Posterior lumbar interbody fusion (PLIF) – the disc is accessed from a posterior incision.

Transforaminal lumbar interbody fusion (TLIF) – the disc is accessed from a posterior incision on one side of the spine.

Transpsoas interbody fusion (DLIF or XLIF) – the disc is accessed from an incision through the psoas muscle on one side of the spine.

Contraindications

Bone morphogenetic protein (rhBMP) should not be routinely used in any type of anterior cervical spine fusion, such as with anterior cervical discectomy and fusion. There are reports of this therapy causing swelling of soft tissue which in turn can cause life-threatening complications due to difficulty swallowing and pressure on the respiratory tract.

Epidemiology

According to a report by the Agency for Healthcare Research and Quality (AHRQ), approximately 488,000 spinal fusions were performed during U.S. hospital stays in 2011 (a rate of 15.7 stays per 10,000 population), which accounted for 3.1% of all operating room procedures.[3] This was a 70 percent growth in procedures from 2001.

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