i have some ? About a second fusion. I
have a tri-level fusion l2 -l5 fusion done
in april 2005. Also had all of the disk
removed. My ? Is, when they do the
second fusion, and because the bone graft
is place before the hardware is placed.
Will they have to remove the screws and
rods first so they can put more graft on.
Or can they graft around the existing
hardware?
after spine fusion surgery, the body
engages in a natural process to repair
itself, which usually means growing bone.
As the harvested bone graft grows and
adheres to the transverse processes, such
as between l4 and l5 (lumbar segment 4 and
lumbar segment 5), the spinal fusion is
achieved and motion at that segment is
stopped. Spine surgery instrumentation
(medical devices, such as pedicle screws
or cages) is sometimes used as an adjunct
to obtain a solid fusion.
However, a solid fusion is not always
achieved. There are two types of bone
cells, one (osteoblast) that grows bone
and another (osteoclast) that removes
bone. It is a race between these two
cell types for the spine fusion to
successfully set up. There are a couple
of key factors that patients can control
that are important in determining whether
or not a fusion grows in solidly,
including:
smoking cessation. It is generally
advisable to quit smoking prior to a
spinal fusion surgery, as nicotine is a
direct toxin to bone graft and will
prevent the bone from forming.
Limited motion. Bone forms better if
motion is limited, so patients are advised
to avoid bending, lifting, and twisting
for three months after spinal fusion
surgery.
Most spine fusions will set up within
three months, and will continue to get
stronger for one to two years. Once a
solid fusion is achieved it is very
unlikely that it will ever break.
Recurrent pain after a successful spine
fusion surgery is generally not from the
fused level, but can be from any of the
other joints.
A "transfer" lesion can occur especially
if more than one level is fused. This is
the result of increased stress being
transferred to the next level. Although
this has been well documented in
multi-level spine fusions, it is less
clear if doing a one level fusion leads to
a higher incidence of joint breakdown than
in the general population (than for people
who have not had a spine fusion surgery).
Posterolateral gutter spine fusion risks
and complications
the principal risk of this type of low
back surgery is that a solid fusion will
not be obtained (nonunion) and further
surgery to re-fuse the spine may be
necessary. Nonunion rates of between 10%
and 40% have been quoted in the medical
literature.
Nonunion rates are higher for patients who
have had prior surgery, patients who smoke
or are obese, patients who have multiple
level spine fusion surgery, and for
patients who have been treated with
radiation for cancer.
Not all patients who have a nonunion will
need to have another fusion procedure.
As long as the joint is stable, and the
patient's symptoms are better, more back
surgery is not necessary.
Other than nonunion, the risks of a spinal
fusion surgery include infection or
bleeding. These complications are fairly
uncommon (approximately 1% to 3%
occurrence). In addition, there is a
risk of achieving a successful fusion, but
the patient's pain does not subside.
a major risk is that you might actually
not get a solid fusion, which is called
pseudoarthrosis (or nonunion) or when the
joint is still there and still moving.
With modern instrumentation systems and
modern techniques, pseudoarthrosis rates
are going down quite a bit. But there
are still failures more often than not
because we haven’t identified the pain
generator even though we are getting
better fusions.
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This page was last updated on June 11, 2008
