Patients with spinal instability or chronic back pain may require spinal fusion surgery. This surgery is done to stabilize and strengthen the spine and to alleviate severe, chronic back pain. Spinal fusion surgery is a common treatment for such spinal disorders as spondylolisthesis, scoliosis, severe disc degeneration or spinal fractures. Fusion surgery is usually considered only after non-operative therapies have failed.

What is fusion?
Spinal fusion is the joining or fusing of two or more vertebrae. Bone graft is traditionally used to facilitate fusion. This involves small amounts of bone being taken from the patient's hip (autograft), or from a donor (all graft), and then packed between the vertebrae in order to "fuse" them together.

Specially designed implants (including cages, rods, hooks and screws) are also often used in a fusion surgery. The implants are used to ensure correct positioning between vertebrae and to help successful fusion to take place. In addition, these implants add strength and stability to the spine and aid in the healing process.

Rod instrumentation to facilitate fusion

A fusion is not always achieved after surgery. Fusion rates vary depending on such factors as whether or not the patient smokes, and the underlying pathology. However, there has recently been a breakthrough relating to fusions. Surgeons are now able to use bone morphogenetic proteins (BMPs) during surgery to facilitate fusion. BMP is a "substance" that causes bone growth. The use of BMP in fusion surgery is already improving fusion rates.

PLIF and ALIF
The two most common fusion techniques used to treat chronic low back pain are PLIF and ALIF.

PLIF stands for Posterior Lumbar Interbody Fusion. It is a fusion technique done from the back (posterior) of the lumbar spine. The PLIF procedure involves three basic steps:

1. Pre-operative planning and templating. Before the surgery, the surgeon will use MRI and CAT scans to determine what size implant(s) the patient will need.
   
   
2. Preparing the disc space. An incision is made and back muscles are retracted to allow access to the vertebral disc. The surgeon then carefully removes some or all of the affected disc and surrounding tissue.
   
   
3. Implants Inserted. Once the disc space is prepared, bone graft, or BMP with a cage, is inserted to promote fusion between the vertebrae. Additional implants may also be used at this time to further stabilize the spine.

Bone model showing cage, rod, and screw

ALIF, which stands for Anterior Lumbar Interbody Fusion, is similar to PLIF, however it is done from the front (anterior) of the body. CCSI's surgeons are leaders in this technique, and are currently involved in the development of specialized implants for use with ALIF procedures for surgeons worldwide.

Conclusion
For some spinal disorders your doctors at CCSI will recommend spinal fusion surgery. The surgeons at CCSI are highly skilled with these types of surgeries. Furthermore, the arrival of new tools such as BMPs further enhances the likelihood of a successful fusion being achieved.