Spinal fusion is one of the most common surgeries performed in the back. The basic idea is to fuse painful or unstable bones in the spine so that they heal into a single, solid bone. For bones to fuse or heal together, additional bone is needed. This additional bone is called a bone graft. The rigidity of using a bone graft supports weight-bearing functions such as walking and standing. If left untreated or left too long to be treated, Lumbar Spinal Stenosis (LSS) can lead to a decreased quality of life. It not only hinders the ability to participate in activities of daily living, work, hobbies, or interests, but it will also likely worsen over time and lead to more serious issues like nerve damage and paralysis. The time to consult with the extensively trained and experienced orthopedic specialists at OCC – Advanced Orthopedic & Sports Medicine Specialists in Denver, Parker, or Aurora, Colorado, is before it gets to that point. They’ve got all the help you need.

OVERVIEW

Spinal stenosis is fairly common, with degenerative spinal changes affecting up to 95% of people by the age of 50. It is a narrowing of the spinal canal that often occurs as a result of disk degeneration or herniation, a partial dislocation of the vertebrae, overgrowth of the facets, or thickening of the ligaments. More than 300,000 lumbar spinal fusions are performed every year. Spinal fusion involves techniques designed to mimic the normal healing process of broken bones. Typically, a bone graft is used to fuse the vertebrae during the surgery. The bone graft is added between the vertebrae to set up the required conditions for the formation of a solid bone bridge. In some spinal fusion procedures, parts of the spinal bones are removed to relieve pressure on the nerve roots. This removed bone is often saved during the surgery and used as a graft. The bone is essentially recycled; it is moved from an area where it is no longer needed to the area that the surgeon wants to fuse.

ABOUT THE SPINE

The spine is one of the most important parts of the body. Without it, one could not keep themselves upright or even stand up. It gives the body structure and support. It allows one to move about freely and bend with flexibility. The spine is also designed to protect the spinal cord. The spine is made up of 33 vertebrae that are stacked on top of each other to create the spinal column – 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 4 coccygeal. The coccyx is the last bone at the bottom (base) of your spine. Most people know the coccyx as the tailbone.

Between each vertebra is a soft gel-like cushion called a disc that helps absorb pressure and keep the bones from rubbing against each other. The spine itself has three main segments: the cervical or upper part of the spine, the thoracic or center portion of the spine, and the lumbar or lower part of the spine. Even though the lower portion of the spine holds most of the body’s weight, each segment relies upon the strength of the others to function properly.

WHAT ARE BONE GRAFTS IN SPINAL SURGERY?

A basic part of any spinal fusion involves a bone graft. A bone graft refers to a supporting structure. Different types of bone grafts used in spinal fusion:

• Cadaver or Autografts: These are considered the gold standard for bone grafting. They use bone from the patient’s own body, typically from the iliac crest (hip bone) as they provide live bone cells, growth factors, and proteins necessary for bone regeneration.
• Allografts: These involve using bone tissue obtained from a cadaveric donor. Meanwhile, this type of bone graft eliminates the need for an additional surgical site. 
• Synthetic Bone Grafts: These mimic the properties of natural bone. Although synthetic, they provide a framework for new bone growth and gradually resorb over time as the patient’s own bone takes its place.
• Bone Morphogenetic Proteins (BMPs): These are a group of naturally occurring proteins that play a critical role in bone formation and healing. Surgeons use these as an alternative or in combination with traditional bone grafts.
• Interbody Cage Fusion: This procedure uses a hollow threaded or carbon fiber cylinder to fuse two vertebrae. The diseased disk is removed and two interbody cages are placed in the opening where the diseased disk has been removed. The cages are filled with bone grafts.

CAUSES

Spinal fusion may be used for a variety of health conditions:

• Injury or fractures to the bones in the spine
• Weak or unstable spine caused by infection or tumors
• Spondylolisthesis, a condition in which one vertebrae slips forward on top of another
• Abnormal curvatures such as those from scoliosis
• Degenerative disc disease
• Spinal stenosis

SYMPTOMS

Symptomatic LSS typically starts gradually. As the spinal canal narrows, it can compress the nerve roots, eventually causing:

• Back pain
• Heaviness
• Weakness
• Paresthesia: the feeling of tingling, numbness, or “pins and needles” in the buttocks, legs, and feet during walking or prolonged standing
• Burning pain going into the buttocks and down into the legs (sciatica)
• A weakness in the foot that causes the foot to slap down when walking. This is also called drop-foot

Pressure on nerves in the lumbar region can also cause more serious symptoms:

• Loss of bowel or bladder control
• Severe or increasing numbness between legs, inner thighs, and back of the legs
• Severe pain and weakness that makes it hard to walk or to get out of a chair

NON-SURGICAL TREATMENTS

Pain caused by nerve compression is typically relieved by bending forward at the waist to reduce pressure on the affected nerve. In individuals with advanced stenosis, this may no longer provide symptom relief. In this case, other conservative measures may help:

• Pain relievers: Over-the-counter medicines such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve)
• Cortisone injections into the spinal column
• Physical therapy or exercise: This can strengthen back and stomach muscles improving the ability to walk and improving pain

WHEN IS SURGERY INDICATED?

Usually, spine specialists consider surgery only if symptoms such as weakness, numbness, or pain in the arms or legs indicate severe or progressive nerve or spinal cord compression. In addition, if instability in the spine has contributed to spinal stenosis—for example, a vertebra or disc that has slipped out of place is constricting nerves or the spinal cord—surgery may be required to stabilize the spine and prevent further damage. Additionally, spinal stenosis is recommended to help reopen the spinal canal, which when narrowed can cause severe symptoms.

GETTING THE RIGHT DIAGNOSIS. GETTING THE RIGHT DOCTOR.

Just the thought of needing spinal surgery can be unsettling. What helps alleviate the anxiety most, is getting the right orthopedic spine surgeon like those you’ll find at Advanced Orthopedics in Denver, Parker, or Aurora, Colorado. A highly qualified and compassionate surgeon can be your trusted partner in the journey to a healthier, pain-free, and more active life. After a thorough and detailed physical exam, your doctor will look for more symptomatic indications of spinal stenosis. To help, X-rays may show bone growths called spurs that push on the spinal nerves, a narrowing of the spinal canal, or both. Imaging tests such as a CT scan or MRI can give a more detailed look at the spinal canal and nerve structures. If surgery is indicated, your surgeon at Advanced Orthopedics will give you a thorough assessment of your problem in terms you can readily understand. There are different ways to do spinal fusion and many different types of bone grafts. They will take all the time they need to answer your questions and make you as comfortable as possible. Renowned for their expertise and their advancements in surgical procedures, you can feel confident you’ve found the best choice. Schedule an appointment with a spine specialist today.