Spine Fusion Surgery: An Overview

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Spine Fusion Surgery: An Overview




Guest:  Dr. John Glaser – Orthopedic Surgery

Host:  Dr. Linda Austin – Psychiatry


Dr. Linda Austin:  I’m Dr. Linda Austin.  Today I’m interviewing Dr. John Glaser, who is Professor of Orthopedic Surgery and an expert here, at MUSC, in spine surgery.  I want to get to the topic, Dr. Glaser, of spine fusion surgery, but I have one basic question, first.  A couple of different kinds of surgeons can do spine surgery.  Who is trained to the kind of surgery you do?


Dr. John Glaser:  That’s right.  In general, the people who do spine surgery are neurosurgeons or orthopedic surgeons.  There are a few crazed people out there who actually trained in both.  Historically, the orthopedic surgeon would deal with the structural part of spine surgery, scoliosis or spine fusions, and the neurosurgeons would deal with the decompression part of surgery.


Dr. Linda Austin:  Decompression, meaning?


Dr. John Glaser:  Such as a laminectomy for a disc problem, or if someone had a spinal stenosis, a narrowing of the area for the nerves.  As time has gone on, the orthopedic surgeons have expanded to doing much of the decompressive surgery, and the neurosurgeons have often expanded to doing much of the structural surgery.  So, often times, many of my neurosurgical colleagues may not agree, but we’re often interchangeable parts for a majority of the problems that an average adult would have with their spine. 


Dr. Linda Austin:  And, in that way, not dissimilar from many areas of medicine, where, now, there are folks trained in different specialties who can do similar sorts of procedures.  Let’s talk now about spinal fusion, a very common procedure.  When is that surgery indicated?  Who gets that operation?


Dr. John Glaser:  Spinal fusion is a procedure to biologically weld two or more of the bones of the spine together into one solid bone.  The people who generally get it are the people who have severe degeneration of their spine with pain, so that it’s irritating nerves or causing deformity, or people who have a deformity such as scoliosis of their spine.  The other folks who will end up getting a spine fusion are, for instance, people who have a disc problem in their neck, where the procedure to take care of the disc problem is removal of the entire disc.  And, once you remove the entire disc, if you don’t put something in there, the segment of the spine will degenerate badly.  So, most of the people in that situation will end up with a spine fusion.  And there are other somewhat more rare things, if someone has a bad infection of their spine or a tumor of their spine that needs be taken out, leaving them with a large gap, they end up with a spine fusion to fill that.


Dr. Linda Austin:  Can you describe that operation, please?  How do you go about doing a fusion?


Dr. John Glaser:  There are a lot of ways to do the actual carpentry of the fusion.  The most common technique is done from the posterior part of the spine or the back, where we go through the muscles or move them aside.  We take the area of the spine and we roughen it up.  We remove the outer layer of bone to get to the marrow elements where the cells that can help with the fusion are found, and we add bone graft of some sort.  Or, more commonly, these days, a bone substitute or a processed donated bone, which is not the patient’s own bone, so that we don’t have to take a bone graft from somewhere else, we often will add some other factors to help it heal, such as some proteins that can stimulate bone healing or some instrumentation, some screws and rods to hold it rigidly in place.  The primary biology is to get the bone to bridge across from one of the vertebral bodies to the others so that they become a solid piece of bone.  The thinking there is if it’s a solid piece of bone, it doesn’t move.  If it doesn’t move, it shouldn’t hurt.


Dr. Linda Austin:  And, is that, indeed, the case?  Do you see decreased pain in those patients over time?


Dr. John Glaser:  Most people will have a decrease in pain, but very few are pain free.  We’re not good enough to make it normal.


Dr. Lind Austin:  Is it possible, or advisable, at times, to get more than one fusion, more than one segment fused?


Dr. John Glaser:  Yes.  There are times we’d have to fuse two or three, four, or many segments, and that depends on the actual problem.  For instance, people with scoliosis generally need a large number of segments of their spine fused.  For people who have the degenerative problems, we do our best to limit the number of levels we do, although, at times, we do have to do more levels. 


Dr. Linda Austin:  I would imagine that the tradeoff, then, is a loss of flexibility, mobility, in the spine.  Am I right about that?


Dr. John Glaser:  Yes.  You do lose some mobility of the spine.  Many people, though, find that their mobility is better than it was before surgery because they don’t hurt as much.  They have less mobility than someone who is normal, but more than they had prior to the surgery.


Dr. Linda Austin:  Interesting.  What are some adverse consequences of this surgery?  What are legitimate things to be concerned about? 


Dr. John Glaser:  Well, the most common problem, I think, of spine fusion surgery is that it just doesn’t make you feel as good as you want to.  We can have the perfect patient who has the absolutely correct indications and an operation that goes just fine, and they still hurt.  And sometimes we don’t know why.  Now, fortunately, that’s not very common, but it is one of the more common problems we run into.  There are, of course, the standard potential complications from any surgery, infection and bleeding.  And, as you mentioned, the loss of mobility can be bothersome for people who are quite active.  The thing that is quite debated in the spine world but, I think, can be a problem long term is if you take one segment of the spine and make it stiff and solid, the stresses of everyday life are transferred to the next segment up and the next segment down, and they wear out faster than they normally would if you had not done a fusion.


Dr. Linda Austin:  Are there age limits for getting this surgery? 


Dr. John Glaser:  The most common age range is about 40 to 60 years old.  But I have done spine fusion surgery on people into their late 80s and young teenagers, if they need it.  So, there really is not an upper age range, as long as someone is healthy and able to tolerate the surgery and is bad enough off to need it.


Dr. Linda Austin:  What’s on the horizon in this area?  What are some of the newer techniques and strategies?


Dr. John Glaser:  There are some very fascinating new proteins that have now been on the market for spine fusion, for a number of years, for some indications.  They’re called bone morphogenetic proteins.  These are proteins that are circulating in everybody’s body in small amounts.  They’ve managed to purify them and manufacture them so we can now apply them in surgery.  There are two that are now on the market, and they can stimulate the cells in the area where you place them to turn to cells that form bone.  So, we believe they will increase our success rate of getting a solid fusion when we do this.  One of the complications of spine fusion surgery is that the fusion doesn’t take and people don’t get the solid bone.  And we feel this is going to significantly increase our success rate at getting this to solidly fuse.


Dr. Linda Austin:  Dr. Glaser, thank you very much.


Dr. John Glaser:  Well, thank you.


If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection:  (843) 792-1414.


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