Spinal Instability can also be described as the situation in which the spinal column is unable to support itself normally owing to certain physiological changes or diseases. In a healthy spine, the vertebrae are in their correct position; the discs that lie between the vertebrae help support and cushion the spine. With the situation in the spine unstable, the individual vertebra can shift or move in an undesirable manner, causing pain, pressure on nerves, and limitations to mobility. This condition can be primary or secondary and may be due to other conditions such as degenerative disc disease, trauma, infection, tumors or congenital abnormalities.
Spinal Fusion Surgery is a surgical intervention applied in the treatment of spinal instability by combining two or more of the vertebrae to reduce mobility. Spinal fusion is done with the purpose of stiffening the spine, relieving pain and allowing better function. The surgery is mostly done when other effective methods such as physical therapy, medication, and adjustment of lifestyle is not useful.
Indications
Degenerative Disc Disease (DDD): This is a common cause of spinal instability, particularly in the lumbar (lower) and cervical (neck) regions. The intervertebral discs lose their height and elasticity, leading to misalignment of the spine.
Indicated when there is severe pain or dysfunction, with or without nerve compression.
Spondylolisthesis: A condition where one vertebra slips forward over the one below it. This can lead to instability, nerve compression, and pain.
Indicated when conservative treatments fail and the condition results in significant pain, weakness, or nerve symptoms.
Spinal Trauma or Fractures: Often, instability can result if there are injured vertebrae or torn ligaments because of traumatic injuries to the spinal area such as in car accidents or falls.
Spinal Deformities: Conditions including scoliosis, which is a lateral deviation of the spine, and kyphosis an exaggerated forward rounding of the spine may cause the deformity to increase or if already large, become unstable.
Spinal Tumors: Primary neoplasms but also secondary metastatic tumors may compromise the integrity of the vertebral elements and weaken the spine so that vertebral collapse becomes a possibility.
This is done when there is spinal deformity, pain, or neurological dysfunction resulting from tumour infiltration.
Contraindications
Severe Osteoporosis or Poor Bone Quality: Patients with osteoporosis or their bone loss condition may have poor bone healing or improper screw fixation and increased the risk of fusion failure.
Active Infection: Just like any spinal infection or any infection in the body increases the risk of wound infection or septic arthritis.
Uncontrolled Medical Conditions: Uncontrolled diabetes, severe coronary artery disease or any other serious systematic illnesses may pose high risk to any surgery.
Poor General Health or High Surgical Risk: They identified patients with poor general health, or patient with advanced age, multiple comorbidities, as possibly at a higher risk of complications from the procedure.
Spinal tumors: Active or aggressive spinal tumors may not be suitable for fusion surgery due to concerns about cancer progression or the potential need for additional treatments like radiation or chemotherapy.
Outcomes
Equipment’s
Equipment’s
Pedicle Screws and Rods
Bone Grafts or Synthetic Materials
Cage Implants
Plates and Screws
Minimally Invasive Surgical Tools
Spinal Navigation Systems
Intraoperative Monitoring Equipment
Surgical Drills and Reamers
Spinal Fusion Robot-Assisted Systems
Patient Preparation
Patient preparation for spinal fusion surgery
Preoperative Evaluation
Medical History and Physical Exam: Ask the patient about any spine conditions, surgeries or injury that occurred in the past.
Review any prior spine conditions, surgeries, or injuries.
Imaging Studies: X-rays, MRI, or CT scans to determine the extent of instability and plan the fusion.
Diagnostic Tests:
Blood work: CBC, coagulation profile, and electrolyte levels are checked.
Specialist Consultations:
Neurology or Neurosurgery: Evaluate for neurological signs or abnormal reflexes.
Rheumatology/Endocrinology: In case, where factors such as osteoporosis or inflammation-driven pathologies are contributing.
Patient Education: Spinal instability is a complex entity, and the goals of fusion surgery are multifaceted.
Focus on possible threats and opportunities, potential advantages and probable consequences.
Explain the rehabilitation plan, physiotherapy and limitations on physical activity.
Patient Positioning
Position: Prone (face-down)
Support:
Chest and abdomen supported with special cushions or frames, like Wilson frame or Jackson table, that prevent compression of the abdomen and maintain spinal alignment.
Arms held to side or on padded armrests, avoiding hyperextension.
Head immobilized by a Mayfield head clamp or other devices for cervical surgery.
Preoperative Preparation:
 1-Preoperative Preparation:
Patient Evaluation:
Conduct imaging studies (X-ray, CT, MRI) to identify the area of instability.
Evaluate the patient’s overall health, including comorbidities.
Obtain informed consent and explain risks, benefits, and alternatives.
Anesthesia:
Administer general anesthesia to ensure patient comfort during surgery.
Positioning:
Position the patient based on the surgical approach (prone for posterior fusion, supine for anterior fusion).
Ensure proper padding to avoid pressure injuries.
Step 2-Incision and Exposure:
Make an incision over the affected spinal segment.
Retract soft tissues to expose the vertebrae and protect neural structures.
Step 3-Preparation of Fusion Area:
Remove intervertebral disc material (if necessary) using tools like curettes and rongeurs.
Decorticate (scrape) bone surfaces to stimulate bone growth.
Step 4-Implant Placement:
Insert pedicle screws into the vertebrae using anatomical landmarks and imaging guidance.
Place rods to connect the screws and provide structural support.
Step 5-Bone Grafting:
Place bone graft material (autograft, allograft, or synthetic) between the vertebrae.
The graft material promotes bone fusion and stability.
Step 6-Additional Stabilization (if necessary):
Use cages, plates, or spacers for additional support in specific cases, such as severe instability.
Step 7-Closure and Recovery:
Wound Closure:
Verify hardware placement using intraoperative imaging (e.g., fluoroscopy).
Close the wound in layers using sutures or staples.
Step 8-Postoperative Care:
Monitor for complications like infection, hardware failure, or nerve damage.
Implement pain management and early mobilization protocols.
Step 9-Rehabilitation:
Begin physical therapy to strengthen supporting muscles.
Gradually increase activities while avoiding heavy lifting or twisting.
Complications
Surgical Site Complications
Infection: Surgical site infection that affects the skin and subcutaneous tissue adjacent to the incision.
The infection may extend to the vertebrae or intervertebral space and may need multiple operations and additional antibiotics.
Wound healing issues: Poor healing due to diabetes, smoking, or poor nutrition.
Neurological Complications
Nerve root injury: Numbness, weakness or chronic pain often results from compression or when an area is accidentally damaged during surgery.
Spinal cord injury: Occasionally though potentially fatal, it may lead to paralysis or a lack of bowel/bladder control.
Fusion Failure
Pseudoarthrosis: Non-union of the graft leading to instability and increased pain at the graft site. This condition is more common in smokers, the obese, and patients with osteoporosis.
Non-union: Like pseudoarthrosis, there is no fusion and revision surgery are often necessary for this indication.
»
Home » Procedure » Spinal Instability and Spinal Fusion Surgery
Spinal Instability and Spinal Fusion Surgery
Updated :
January 23, 2025
Spinal Instability can also be described as the situation in which the spinal column is unable to support itself normally owing to certain physiological changes or diseases. In a healthy spine, the vertebrae are in their correct position; the discs that lie between the vertebrae help support and cushion the spine. With the situation in the spine unstable, the individual vertebra can shift or move in an undesirable manner, causing pain, pressure on nerves, and limitations to mobility. This condition can be primary or secondary and may be due to other conditions such as degenerative disc disease, trauma, infection, tumors or congenital abnormalities.
Spinal Fusion Surgery is a surgical intervention applied in the treatment of spinal instability by combining two or more of the vertebrae to reduce mobility. Spinal fusion is done with the purpose of stiffening the spine, relieving pain and allowing better function. The surgery is mostly done when other effective methods such as physical therapy, medication, and adjustment of lifestyle is not useful.
Degenerative Disc Disease (DDD): This is a common cause of spinal instability, particularly in the lumbar (lower) and cervical (neck) regions. The intervertebral discs lose their height and elasticity, leading to misalignment of the spine.
Indicated when there is severe pain or dysfunction, with or without nerve compression.
Spondylolisthesis: A condition where one vertebra slips forward over the one below it. This can lead to instability, nerve compression, and pain.
Indicated when conservative treatments fail and the condition results in significant pain, weakness, or nerve symptoms.
Spinal Trauma or Fractures: Often, instability can result if there are injured vertebrae or torn ligaments because of traumatic injuries to the spinal area such as in car accidents or falls.
Spinal Deformities: Conditions including scoliosis, which is a lateral deviation of the spine, and kyphosis an exaggerated forward rounding of the spine may cause the deformity to increase or if already large, become unstable.
Spinal Tumors: Primary neoplasms but also secondary metastatic tumors may compromise the integrity of the vertebral elements and weaken the spine so that vertebral collapse becomes a possibility.
This is done when there is spinal deformity, pain, or neurological dysfunction resulting from tumour infiltration.
Severe Osteoporosis or Poor Bone Quality: Patients with osteoporosis or their bone loss condition may have poor bone healing or improper screw fixation and increased the risk of fusion failure.
Active Infection: Just like any spinal infection or any infection in the body increases the risk of wound infection or septic arthritis.
Uncontrolled Medical Conditions: Uncontrolled diabetes, severe coronary artery disease or any other serious systematic illnesses may pose high risk to any surgery.
Poor General Health or High Surgical Risk: They identified patients with poor general health, or patient with advanced age, multiple comorbidities, as possibly at a higher risk of complications from the procedure.
Spinal tumors: Active or aggressive spinal tumors may not be suitable for fusion surgery due to concerns about cancer progression or the potential need for additional treatments like radiation or chemotherapy.
Equipment’s
Pedicle Screws and Rods
Bone Grafts or Synthetic Materials
Cage Implants
Plates and Screws
Minimally Invasive Surgical Tools
Spinal Navigation Systems
Intraoperative Monitoring Equipment
Surgical Drills and Reamers
Spinal Fusion Robot-Assisted Systems
Patient Preparation
Patient preparation for spinal fusion surgery
Preoperative Evaluation
Medical History and Physical Exam: Ask the patient about any spine conditions, surgeries or injury that occurred in the past.
Review any prior spine conditions, surgeries, or injuries.
Imaging Studies: X-rays, MRI, or CT scans to determine the extent of instability and plan the fusion.
Diagnostic Tests:
Blood work: CBC, coagulation profile, and electrolyte levels are checked.
Specialist Consultations:
Neurology or Neurosurgery: Evaluate for neurological signs or abnormal reflexes.
Rheumatology/Endocrinology: In case, where factors such as osteoporosis or inflammation-driven pathologies are contributing.
Patient Education: Spinal instability is a complex entity, and the goals of fusion surgery are multifaceted.
Focus on possible threats and opportunities, potential advantages and probable consequences.
Explain the rehabilitation plan, physiotherapy and limitations on physical activity.
Patient Positioning
Position: Prone (face-down)
Support:
Chest and abdomen supported with special cushions or frames, like Wilson frame or Jackson table, that prevent compression of the abdomen and maintain spinal alignment.
Arms held to side or on padded armrests, avoiding hyperextension.
Head immobilized by a Mayfield head clamp or other devices for cervical surgery.
 1-Preoperative Preparation:
Patient Evaluation:
Conduct imaging studies (X-ray, CT, MRI) to identify the area of instability.
Evaluate the patient’s overall health, including comorbidities.
Obtain informed consent and explain risks, benefits, and alternatives.
Anesthesia:
Administer general anesthesia to ensure patient comfort during surgery.
Positioning:
Position the patient based on the surgical approach (prone for posterior fusion, supine for anterior fusion).
Ensure proper padding to avoid pressure injuries.
Step 2-Incision and Exposure:
Make an incision over the affected spinal segment.
Retract soft tissues to expose the vertebrae and protect neural structures.
Step 3-Preparation of Fusion Area:
Remove intervertebral disc material (if necessary) using tools like curettes and rongeurs.
Decorticate (scrape) bone surfaces to stimulate bone growth.
Step 4-Implant Placement:
Insert pedicle screws into the vertebrae using anatomical landmarks and imaging guidance.
Place rods to connect the screws and provide structural support.
Step 5-Bone Grafting:
Place bone graft material (autograft, allograft, or synthetic) between the vertebrae.
The graft material promotes bone fusion and stability.
Step 6-Additional Stabilization (if necessary):
Use cages, plates, or spacers for additional support in specific cases, such as severe instability.
Step 7-Closure and Recovery:
Wound Closure:
Verify hardware placement using intraoperative imaging (e.g., fluoroscopy).
Close the wound in layers using sutures or staples.
Step 8-Postoperative Care:
Monitor for complications like infection, hardware failure, or nerve damage.
Implement pain management and early mobilization protocols.
Step 9-Rehabilitation:
Begin physical therapy to strengthen supporting muscles.
Gradually increase activities while avoiding heavy lifting or twisting.
Complications
Surgical Site Complications
Infection: Surgical site infection that affects the skin and subcutaneous tissue adjacent to the incision.
The infection may extend to the vertebrae or intervertebral space and may need multiple operations and additional antibiotics.
Wound healing issues: Poor healing due to diabetes, smoking, or poor nutrition.
Neurological Complications
Nerve root injury: Numbness, weakness or chronic pain often results from compression or when an area is accidentally damaged during surgery.
Spinal cord injury: Occasionally though potentially fatal, it may lead to paralysis or a lack of bowel/bladder control.
Fusion Failure
Pseudoarthrosis: Non-union of the graft leading to instability and increased pain at the graft site. This condition is more common in smokers, the obese, and patients with osteoporosis.
Non-union: Like pseudoarthrosis, there is no fusion and revision surgery are often necessary for this indication.
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