Spinal Fusion Treatment In Singapore

Spinal fusion is a procedure that aims to provide long-term pain relief and improve spinal stability. Consult our neurosurgeon today for a detailed assessment of your condition and a personalised treatment plan.

Dr Ng Zhi Xu OLD
Dr Ng Zhi Xu OLD
Senior Consultant Neurosurgeon

What Is Spinal Fusion

Spinal fusion is a surgical procedure designed to join two or more vertebrae in the spine to form a single, solid structure. The primary objective of this operation is to eliminate motion between adjacent vertebrae, thereby alleviating symptoms related to conditions such as degenerative disc disease, spondylolisthesis, spinal stenosis, and vertebral fractures. By restricting movement in the affected segments of the spine, spinal fusion aims to provide long-term pain relief and improve spinal stability.

Anatomy of the Spine

The vertebral column, commonly referred to as the spine, is a complex structure made up of 33 vertebrae. These vertebrae are categorised into five regions:

  • Cervical (neck)
  • Thoracic (mid-back)
  • Lumbar (lower back)
  • Sacral
  • Coccygeal (tailbone)

 

Each vertebra is separated by an intervertebral disc, which functions as a cushion to absorb shock and facilitate spinal movement.

Intervertebral discs are composed of a soft, gel-like centre known as the nucleus pulposus, encased by a tougher, fibrous outer layer called the annulus fibrosus. These discs play a pivotal role in maintaining spinal flexibility, thereby enabling a range of movements such as bending and twisting.

Facet joints are small joints between the vertebrae that allow for spinal movement, and they often become the focus in fusion surgeries aimed at restricting this movement. Pedicles are bony protrusions from the vertebrae that serve as anchor points for surgical hardware during fusion procedures.

Indications for Spinal Fusion

Degenerative Disc Disease (DDD) is a condition where the intervertebral discs lose their structural integrity due to ageing or wear and tear. As the discs degenerate, they may no longer effectively cushion the vertebrae, leading to pain and instability. Spinal fusion is indicated for severe cases of DDD to eliminate motion at the affected segment and thus alleviate symptoms.

Spondylolisthesis occurs when one vertebra slips forward over the vertebra below it. This misalignment can compress spinal nerves and result in pain, numbness, or weakness in the lower back and legs. Spinal fusion aims to correct the alignment by joining the slipped vertebra to adjacent vertebrae, thereby stabilising the spine.

Spinal stenosis is a narrowing of the spinal canal, which can put pressure on the spinal cord and nerves. Symptoms may include pain, numbness, and loss of motor function. Spinal fusion may be indicated in conjunction with decompressive surgery, such as laminectomy, to stabilise the spinal column after the removal of the structures causing the stenosis.

Vertebral fractures can be caused by trauma or weakened bones due to conditions like osteoporosis. These fractures can result in severe pain and spinal deformity. Spinal fusion can provide stability to the fractured vertebrae, promoting healing and reducing pain by eliminating motion at the fracture site.

Types of Spinal Fusion

Posterior Spinal Fusion

The surgeon approaches the spine from the back to join the vertebrae. Rods and screws are usually implanted to secure the vertebrae in place. This technique is commonly employed for conditions like scoliosis and is often combined with other procedures such as laminectomy for spinal stenosis.

Anterior Lumbar Interbody Fusion (ALIF)

Anterior Lumbar Interbody Fusion involves approaching the spine from the front. After removing the degenerated disc, a bone graft or synthetic material is inserted into the disc space between vertebrae to encourage fusion. This technique is primarily used for treating degenerative disc disease and spondylolisthesis in the lumbar region.

Transforaminal Lumbar Interbody Fusion (TLIF)

Transforaminal Lumbar Interbody Fusion is a variant of posterior fusion. The surgeon removes a portion of bone and disc material from the side (foramen) to insert a cage filled with bone graft. TLIF is effective for treating conditions like degenerative disc disease, spondylolisthesis, and spinal stenosis.

Extreme Lateral Interbody Fusion (XLIF)

Extreme Lateral Interbody Fusion is a minimally invasive procedure where the surgeon accesses the spine from the side. This approach avoids significant muscle dissection, resulting in less postoperative pain and a quicker recovery. XLIF is often employed for degenerative conditions and deformities involving the lumbar and lower thoracic regions.

Pre-operative Preparation

Pre-surgery Assessments

  • Medical History and Physical Examination: Comprehensive review of the patient’s medical history and a focused examination of the spinal region.
  • Radiological Studies: Imaging tests such as X-rays, MRI, or CT scans to visualize the spine’s anatomy and pathology.
  • Blood Tests: Complete blood count, coagulation profile, and biochemical tests to assess overall health and rule out contraindications.
  • Cardiopulmonary Assessments: EKG and possibly a pulmonary function test to evaluate heart and lung health.

Health Optimization Strategies

  • Nutritional Optimization: Adequate protein and caloric intake are essential for wound healing and combating postoperative fatigue.
  • Smoking Cessation: Smoking is associated with poor bone healing and increased postoperative complications. A cessation programme is strongly recommended.
  • Glucose Control: Patients with diabetes are advised to maintain optimal blood sugar levels to minimize the risk of surgical site infections.
  • Physical Conditioning: A preoperative physiotherapy regimen may be beneficial for enhancing musculoskeletal health and postoperative mobility.

The Surgical Procedure

Spinal fusion surgery generally requires general anaesthesia to induce a state of unconsciousness and muscle relaxation. Regional anaesthesia may be combined with sedation, depending on the surgical approach and extent of fusion.

The surgical approach varies depending on the type of spinal fusion being performed. Common approaches include:

  • Posterior Approach: The surgeon makes an incision along the midline of the back to access the vertebrae.
  • Anterior Approach: An incision is made in the abdomen or neck, depending on the location of the affected vertebrae.
  • Lateral Approach: The surgeon accesses the spine from the side, typically in minimally invasive procedures like XLIF.

 

Regardless of the approach, the basic steps usually involve the removal of the intervertebral disc, insertion of a bone graft or synthetic material, and stabilization of the vertebrae.

  • Pedicle Screws: These are inserted into the vertebral body and are often connected by rods.
  • Anterior Plates: These are used in anterior approaches and are fixed to the vertebral body via screws.
  • Cages: These are inserted into the disc space to provide structural support and may be filled with bone graft material.
  • Rods: These are used to connect pedicle screws, providing additional spinal stability.

 

The choice of hardware is influenced by several factors, including the specific spinal pathology, the surgeon’s expertise, and the chosen surgical approach. The hardware serves to provide immediate stability to the spinal segment, allowing the bone graft to heal and achieve long-term fusion.

Post-operative Care

Immediate Post-surgery Care

Patients are typically transferred to a post-anaesthesia care unit for close monitoring. Vital signs, neurological function, and surgical site condition are regularly assessed. Early mobilisation is usually encouraged within 24 hours, under the guidance of medical staff, to promote blood circulation and mitigate the risk of complications such as deep vein thrombosis.

Rehabilitation Process

  • Physiotherapy: Customised exercise regimens target muscle strengthening, posture correction, and functional mobility.
  • Occupational Therapy: Patients learn techniques for performing daily activities without compromising spinal alignment or surgical outcomes.
  • Progressive Mobilisation: Walking distances and activity levels are incrementally increased, based on individual recovery timelines and physiotherapist assessments.

Pain Management

  • Analgesics: Oral or intravenous medications, often opioids initially, are administered for acute pain control.
  • Corticosteroid Injections: May be used sparingly for inflammation control.
  • Non-pharmacological Interventions: Ice packs, heat therapy, and controlled mobilisation may supplement pharmacological pain management.

Risks and Complications

  • Infection: Postoperative infection can occur superficially at the surgical site or deeper, involving the hardware or spinal structures. Management often includes antibiotic therapy and may require surgical debridement.
  • Hardware Malfunction or Dislodgement: The hardware used for spinal fusion can malfunction, break, or become dislodged. This can compromise the stability of the fusion and necessitate additional surgical intervention to correct or replace the hardware.
  • Non-union of Fused Bones: Known as pseudoarthrosis, this occurs when the bone graft fails to integrate with the adjacent vertebrae, resulting in an incomplete or failed fusion. Revision surgery may be required, and options for treatment may include additional bone grafts or hardware.

Benefits of Spinal Fusion

Pain Relief

Spinal fusion aims to alleviate pain originating from spinal instability or degenerative conditions by immobilizing the affected vertebrae. The absence of movement often leads to significant reductions in pain levels.

Spinal Stabilisation

By fusing unstable or misaligned vertebrae, the procedure provides structural stability to the spinal column, especially for conditions like spondylolisthesis and severe degenerative disc disease, where spinal instability is a primary concern.

Improved Quality of Life

Pain reduction and increased spinal stability often translate into improved physical function and activity levels. Many patients experience an enhanced quality of life post-surgery, including greater capacity for work and leisure activities.

Alternatives to Spinal Fusion

Non-surgical Treatments

  • Physical Therapy: A structured exercise regimen may improve spinal stability and relieve pain.
  • Pain Management: Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroid injections may be used.
  • Activity Modification: Lifestyle changes including ergonomic adjustments and weight loss can have a positive impact on spinal health.

Other Surgical Options

  • Discectomy: Removal of a portion of an intervertebral disc to relieve pressure on a nerve.
  • Laminectomy: Removal of part of the vertebral bone called the lamina to relieve spinal stenosis.
  • Foraminotomy: Widening of the opening where nerve roots exit the spinal canal to alleviate nerve compression.

Frequently Asked
Questions

How Long is the Recovery Period After Spinal Fusion?

Recovery periods may vary based on the type of procedure and individual patient factors. Minimally invasive procedures may require a few weeks, while more complex surgeries may necessitate several months of recovery.

What Are the Success Rates for Spinal Fusion?

Success rates depend on various factors including the specific spinal condition treated and the overall health of the patient. Average success rates can range from 70% to 90% but must be considered in context.

Can I Resume Normal Activities After Spinal Fusion?

Resumption of activities follows a phased approach, usually starting with light activities and advancing to more strenuous tasks over weeks or months. Specific timelines are individualised based on the surgical procedure and patient progress.

Is Spinal Fusion Reversible?

Spinal fusion is a permanent procedure that cannot be reversed. The fused vertebrae are permanently immobilised, which has implications for spinal mobility.

How is Spinal Fusion Different From Other Spinal Surgeries?

Spinal fusion is primarily aimed at stabilising the spinal column, whereas other surgeries like discectomy or laminectomy are geared towards decompression. Each has its own set of benefits and drawbacks.

What Are the Limitations of Spinal Fusion?

Limitations can include a potential decrease in range of motion and the risk of developing adjacent segment disease, a condition where vertebrae adjacent to the fused segment may become problematic.

Can Spinal Fusion Be Performed Alongside Other Spinal Surgeries?

Yes, spinal fusion can be combined with other procedures like laminectomy or discectomy when indicated, usually to achieve both decompression and stabilisation.