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L i s te n to T h e A B M P Po d c a s t a t a b m m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 35 But the short answer to who might need spinal fusion surgery is this: anyone who has signs of bone or disk deformation or instability, along with severe pain that persists for six months or more, in spite of less invasive management strategies. Those strategies typically include physical therapy, spinal injections (with painkillers and/or anti-inflammatories), and medication. It is interesting that massage doesn't appear on this list, but it may be included as part of physical therapy in some cases. The conditions most resources list as correctable by spinal fusion surgery include degenerative disk disease, spondylolisthesis, spinal stenosis, scoliosis, fractured vertebrae, infection, and tumors. Each of these is worth its own discussion, but for now we'll just say they all involve combinations of bone and disk damage that can endanger nerve roots and the spinal cord. WHAT HAPPENS IN THE SPINAL FUSION PROCEDURE? As one might imagine, spinal fusion procedures can be extremely complex. Beyond fusing two or more vertebral bodies together, surgery can also involve a laminectomy (cutting through the lamina to relieve pressure from a damaged disk, bone spurs, or other obstructions), and they often work to create more space between the vertebrae that are being treated; this is called decompression surgery. Depending on what part of the spine is affected, surgery may be conducted through an anterior approach (this is common for cervical fusions), a posterolateral approach, or a fully posterior approach to the spine. The central goal is to link two or more vertebrae in some way that they will heal as a single bone. It's difficult to gather statistics on exactly how many spinal fusion surgeries are conducted, but an organization that tracks device sales suggests that about 352,000 interbody fusions are conducted each year. Grafts are typically inserted between the vertebral bodies to start the fusion process. They can be autografts with bone harvested from the patient's iliac crest or other areas, or allografts with bits of cadaver bone. Various types of synthetic grafts are also used. These can consist of a putty made from demineralized cadaver bone, bone morphogenetic proteins, or synthetic bone made from calcium and phosphate. Exactly which grafts are used depends on the circumstances, and it is common to use multiple types to create appropriate space and to initiate a healing process that will bind the bones together. Then metal plates, screws, and rods are inserted to stabilize the bones as they heal. The recovery process from spinal fusion surgery is predictably slow. Most patients stay in the hospital for about two days, and then return home with instructions for wound care, pain management, and how to safely get in and out of bed. Physical therapy to rebuild strength and flexibility begins a few weeks after surgery and often goes for 3–6 months. Patients are advised not to do any heavy lifting for several weeks and to wear a neck brace if their surgery was for a cervical fusion. Above all, patients are counseled not to smoke, as it has been demonstrated that smokers have poorer success rates with bone grafts. ALTERNATIVES FOR SPINAL FUSION SURGERY Traditional spinal fusion surgery has been used since the early 20th century. It was originally developed to help correct bone loss related to tuberculosis infections, but those surgeons found it also helped reduce severe low-back pain. By definition, spinal fusion surgery leads to loss of function and range of motion in the spine, but this is considered by patients and surgeons to be an acceptable trade-off for the relief it often provides from severe, intractable pain. And the loss of motion at a single spinal segment is so minimal for most people that it doesn't impact their activities of daily living at all. Several options that work to preserve spinal function have been developed, and they are possible choices for people who are worried about full fusions. The two main alternatives to fusion surgery are disk arthroplasty and posterior dynamic stabilization devices. Disk Arthroplasty This is a procedure approved by the US Food and Drug Administration (FDA) in 2004. Debris from a damaged disk is removed, and a prosthetic disk made of metal and plastic is inserted. It is not

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