Spinal instrumentation is a method of keeping the spine rigid after spinal fusion surgery by surgically attaching hooks, rods, and wire to the spine in a way that redistributes the stresses on the bones and keeps them in proper alignment while the bones of the spine fuse.
Spinal instrumentation is used to treat instability and deformity of the spine. Instability occurs when the spine no longer maintains its normal shape during movement. Such instability results in nerve damage, spinal deformities, and disabling pain. Scoliosis (scoliosis) is a side-to-side spinal curvature. Kyphosis is a front-to-back curvature of the upper spine, while lordosis is an excessive curve of the lower spine. More than one type of curve may be present.
Spinal deformities may be caused by:
Spinal instrumentation provides a stable, rigid column that encourages bones to fuse after spinal fusion surgery. Its purpose is to aid fusion. Without fusion, the metal will eventually fatigue and break, and so instrumentation is not itself a treatment for spine deformity.
Different types of spinal instrumentation are used to treat different spinal problems. Although the details of the insertion of rods, wires, screws, and hooks vary, the purpose of all spinal instrumentation is the same—to correct and stabilize the backbone while the bones of the spine fuse. The various instruments are all made of stainless steel, titanium, or titanium alloy.
The oldest form of spinal instrumentation is the Harrington rod. While it was simple in design, it required a long period of brace wearing after the operation, and did not allow segmental adjustment of correction. The Luque rod was developed to avoid the long postoperative bracing period. This system threads wires into the space within each vertebra. The risk of injury to the nerves and spinal cord is higher than with some other forms of instrumentation. Cotrel-Dubousset instrumentation uses hooks and rods in a cross-linked pattern to realign the spine and redistribute the biomechanical stress. The main advantage of Cotrel-Dubousset instrumentation is that because of the extensive cross-linking, the patient may not have to wear a cast or brace after surgery. The disadvantage is the complexity of the operation and the number of hooks and cross-links that may fail.
Several newer systems use screws that are embedded into the portion of the vertebra called the pedicle. Pedicle screws avoid the need for threading wires, but carry the risk of migrating out of the bone and contacting the spinal cord or the aorta (the major blood vessel exiting the heart). During the late 1990s, pedicle screws were the subject of several high-profile lawsuits. The controversies have since subsided, and pedicle screws remain an indispensible part of the spinal instrumentation. Many operations today are performed with a mix of techniques, such as Luque rods in the lower back and hooks and screws up higher. A physician chooses the proper type of instrumentation based on the type of disorder, the age and health of the patient, and the physician's experience.
The surgeon strips the tissue away from the area to be fused. The surface of the bone is peeled away. A piece of bone is removed from the hip and placed along side the area to be fused. The stripping of the bone helps the bone graft to fuse.
After the fusion site is prepared, the rods, hooks, screws, and wires are inserted. There is much variation in how this is done based on the spinal instrumentation chosen. Once the rods are in place, the incision is closed.
Spinal fusion with spinal instrumentation is major surgery. The patient will undergo many tests to determine the nature and exact location of the back problem. These tests are likely to include
In addition, the patient will undergo a battery of blood and urine tests, and possibly an electrocardiogram to provide the surgeon and anesthesiologist with information that will allow the operation to be performed safely. In Harrington rod instrumentation, the patient may be placed in traction or an upper body cast to stretch contracted muscles before surgery.
After surgery, the patient will be confined to bed. A catheter is inserted so that the patient can urinate without getting up. Vital signs are monitored, and the patient's position is changed frequently so that bedsores do not develop.
Recovery from spinal instrumentation can be a long arduous process. Movement is severely limited for a period of time. In certain types of instrumentation, the patient is put in a cast to allow the realigned bones to stay in position until healing takes place. This can be as long as six to eight months. Many patients will need to wear a brace after the cast is removed.
During the recovery period, the patient is taught respiratory exercises to help maintain respiratory function during the time of limited mobility. Physical therapists assist the patient in learning self-care and in performing strengthening and range-of-motion exercises. Length of hospital stay depends on the age and health of the patient, as well as the specific problem that was corrected. The patient can expect to remain under a physician's care for many months.
Spinal instrumentation carries a significant risk of nerve damage and paralysis. The skill of the surgeon can affect the outcome of the operation, so patients should look for a hospital and surgical team that has a lot of experience doing spinal procedures.
Since the hooks and rods of spinal instrumentation are anchored in the bones of the back, spinal instrumentation should not be performed on people with serious osteoporosis. To overcome this limitation, techniques are being explored that help anchor instrumentation in fragile bones.
After surgery there is a risk of infection or an inflammatory reaction due to the presence of the foreign material in the body. Serious infection of the membranes covering the spinal cord and brain can occur. In the long term, the instrumentation may move or break, causing nerve damage and requiring a second surgery. Some bone grafts do not heal well, lengthening the time the patient must spend in a cast or brace or necessitating additional surgery. Casting and wearing a brace may take an emotional toll, especially on young people. Patients who have had spinal instrumentation must avoid contact sports, and, for the rest of their lives, eliminate situations that will abnormally put stress on their spines.
Many young people with scoliosis heal with significantly improved alignment of the spine. Results of spinal instrumentation done for other conditions vary widely.
Mortality rate for spinal fusion surgery is less than 1%. Neurologic injury may occur in 1–5% of cases. Delayed paralysis is possible but rare.
Not all patients require instrumentation with their spinal fusion. For some patients, a rigid external brace can provide the required rigidity to allow the bones to fuse.
"Cotrel-Dubousset Spinal Instrumentation." In Everything You Need to Know About Medical Treatments. Springhouse, PA: Springhouse Corp., 1996.
"Harrington Rod." In Everything You Need to Know About Medical Treatments. Springhouse, PA: Springhouse Corp., 1996.
National Scoliosis Foundation. 5 Cabot Place, Stoughton, MA 020724. (800) 673-6922. http://www.scoliosis.org
Tish Davidson, A.M. Richard Robinson
Spinal instrumentation is performed by a neurosurgical and/or orthopedic surgical team with special experience in spinal operations. The surgery is done in a hospital under general anesthesia. It is done at the same time as spinal fusion.
Do you have any suggestions for me?
There is one other thing I can't explain: his fusion and the surrounding area makes popping, squishy, scraping noises. What causes thi? Is it common?
My surgeon has not given me an explaination. I am interested if you or anyone else has had a similar experience. While i am doing quite well, I do worry that this could lead to a failure of the surgery & more surgery
DO NOT DO THE SURGERY!!! I am 30 years old. I had a T-2 to L-2 spinal fusion. It was a 13 hour surgery and I ended up with 22 screws and 3 rods. The pain I had before my surgery is nothing compared to the pain I have now. Just yesterday I found out the one of my rods, has indead, broke in half. I was told a 12 month recovery. The surgery was 41 months ago, and I have never been in more pain or more miserable in all my life. I have severe neurological pain throughout my entire back, fibromyalgia, neuropathy, and arthritis. I had none of this before the surgery.
Operation is not good solution for sure. I also had L4-L5, L5-S1 fusion, with 6 screws. Though there is not much pain, but I can't sit for long. There are many restriction. I can here some noise in back, but surgeon says ignore it. Not sure, if it is sound of loose screw or anything else.
Operation is not good solution for sure. I also had L4-L5, L5-S1 fusion, with 6 screws. Though there is not much pain, but I can't sit for long. There are many restriction. I can here some noise in back, but surgeon says ignore it. Not sure, if it is sound of loose screw or anything else.
Not sure if anyone can help me.
Am having spinal fusion of T12 thru L5 next week. Cannot find
References to this on the Internet or anyone who can let
Me know what to expect. Help!
Carol
From one Carole to another Carol: I had the same surgery in Jan. of 2010. Mine was supposed to be 5 or 6 hours long but it was 12 hours long. When I awoke I was in the most horrible pain I can imaginne because they couldn't give me pain meds because my blood pressure was too long. I actually thought I was dying.
I was in the hospital for one week but so highly sedated that I have very little memory of it. From the hospital I went to rehab for 3 weeks where I got phys. therapy. At home I got home health care for a few months and then physical therapy for a few weeks. When nothing seemed to be helping, I stopped the pt.
Today, almost 1 1/2 years later I am still in a lot of pain, different pain than before my surgery and my back is very unstable. It's very difficult for me to stand up straight. I use either a walker or a cane except for in the house.
Given another chance I would not have the surgery. I hope yours has a better outcome. Mine was to correct scoliosis. Good luck and I hope my tale is not too depressing.
3 times a day (400 mg ea) reason for surgery, I had bulging disc pinching sciatic nerve in 2 places causing me to feel like I was sitting in coals of fire. Operation seems to have been successful other than the above problems.
I was fused (t5-T9) in 1991, and it didn't help much. I now have an intrathecal drug pump (I'm on my 5th pump in a row) and that does help some. I also have a neurostimulator, which doesn't help with pain, but DOES help to keep me mobile (I swapped one pain for two - but it's worth it!)
If you're interested, please head over to my new weblog, cephasatheos.wordpress.com. I've taught myself neurology, neurophysiology, and I constantly read scientific journal articles and papers - and I ask them questions! And they answer me! So I might be able to help explain some things. I'm not a doctor, but I've been struggling with pain and depression since 1995, and this is my chance to help other people.
It's your body, it's your decision, and if you're intimidated or ignored, you have every right to scream at your doctor or surgeon. DON'T sue them, unless they're idiots. THat just makes it harder for everyone else.
Head over, talk, ask questions, I'll try to help in any way I can.
Cheers,
Pete (Cephas Atheos)
I was fused (t5-T9) in 1991, and it didn't help much. I now have an intrathecal drug pump (I'm on my 5th pump in a row) and that does help some. I also have a neurostimulator, which doesn't help with pain, but DOES help to keep me mobile (I swapped one pain for two - but it's worth it!)
If you're interested, please head over to my new weblog, cephasatheos.wordpress.com. I've taught myself neurology, neurophysiology, and I constantly read scientific journal articles and papers - and I ask them questions! And they answer me! So I might be able to help explain some things. I'm not a doctor, but I've been struggling with pain and depression since 1995, and this is my chance to help other people.
It's your body, it's your decision, and if you're intimidated or ignored, you have every right to scream at your doctor or surgeon. DON'T sue them, unless they're idiots. THat just makes it harder for everyone else.
Head over, talk, ask questions, I'll try to help in any way I can.
Cheers,
Pete (Cephas Atheos)
10 years as I will need surgery on L-3 and L-2. Sure enough he was right as I have been in terrible pain in my buttocks, hips and legs.
1 1/2 years ago I had a Neurostimulator implanted to deal with the pain. It has been of some help. Dr. considers 40% relief is the best
it will do. My pain has now moved over to the left side and is worse than ever. I have had numerous steroid and epidural injections
with no relief. I am now considering to fix the L-2 and L-3, but with the Orthopedic Surgeon who put in my stimulator. They seem to
think differently from Neurosurgeons regarding surgical techniques. I feel I have no other choice at this time but to do more surgery
again as my quality of life has gone down considerately. That is what the Dr asked about. I have to take so much pain medicine to
just walk.I am 70 and was active. I have degenerative disc disease and so do my 2 sisters who have been going through this also.
There was no history of any family members having DDD. The doctors told us that we all have the same weak gene. My question is about
having the surgery again as I need to tell the Dr.when I see him in 3 weeks.
My surgeon once told me "THE ONLY LIMITATIONS IN LIFE ARE WHAT WE PLACE ON OURSELVES". Hope this gives a little help to others.
I was out of the hospital 3 days later but wished it could have been sooner! some of the nurses were really rude.
I spent 1 month doing not much at mums on the recliner in front of the t.v and playing Lego, she looked after me pretty good :) I came home and was out in the backyard doing stuff that I probably shouldn't have been doing, hence I had good days and bad but mostly good and the pain got less and less and the time between bad days got more and more. I was off all pain killers within 6 weeks.
Its been nearly 3 months now, don't really have much pain, muscle aches mostly, but I had those before the injury I think its called getting older. I just stretch them out or get a massage.
I wish I knew if the bones were healed, I just want to go jumping!!
L
3 months ago i was in a horrific car accident thats burst my L3in pieces among other injuries. i had surgery straight away as there was a bone fragment threatening my spinal cord. i had 8 screws and 2 rods inserted and part of my spin removed. I'm 23 and have suffered sever loss of function for everyday things. i go in this monday to see if i can have it all removed or downsized to allow better life but just wondering if anyone has ever made a full recovery or had their instruments removed?? I'm so worried I'm going to be stuck being a potato with next to no movement for the rest of my life.
I awoke on day 111 and wasn’t able to talk or chew food. Intensive bedside therapies then began and I was taught how to swallow again and soon after I was communicating with everyone. It took the bones in my right leg a little longer to heel compared to the left side.
Once it was confirmed as heeled the physio started ... firstly I was taught how to sit on the side of the bed then once I had the green light to weightbare I began to learn how to walk again. Firstly with the aid of Zimmer frame then eventually using two crutches which I still use 18 months on although I’m trying to get down to using just the one crutch with the eventual aim of walking unaided. The traumatic brain injury has left me without a sense of smell , random shakes in my left limbs , no use or sensation in my left foot, urinary incontinent and requiring a permanent catheter , poor vision and complete lack of balance
just yesterday I found a way to see the entire scar on my back.
Pain meds and tranquilizers have got me through the process, and I have been taken Ensure to lose weight so I don't place so much wait on my lower back : L -2 had bursted on a window passanger seat on United Airlines (perhaps they design the window seats for small children) ; the fact is that I had to maneuver out of seat, twisting my back and grabbing the side handles, and all that effort broke 4 vertebreaes L-5, L-4, L-3 and L- 110, so a plate co ered from L-1 through L-5, rod and screws and wiring was used, I can feel them going from my back to my clavicle.
My orders were that I can't carry over 5 pounds, clim stairs one by one, swimming in a pool, doing a few laps, and I still have to log-roll and wear the back-brace.i,m giving it another 2 months, since I had a car crash.
.y husband will drive me to work and do my cases for me if necessary, I have cases next week already.