Preparation for the operation
The preparation for a spondylodesis takes place in the hospital. Usually, the patient is admitted to the hospital the day before. The attending physician first takes a detailed medical history and informs the patient about the course of the operation and possible risks of the procedure.
In the course of a blood withdrawal, the current blood values are examined. In addition, a current X-ray image or magnetic resonance imaging (MRI) is required for the operation. Imaging allows the bony structures and intervertebral discs to be accurately assessed and a suitable surgical technique to be selected.
Procedure of the operation
Spondylodesis is a surgical procedure in which the spine is stiffened. The vertebral bodies are connected to each other with plates and screws, thus stabilizing the spine. The operation takes place under general anesthesia.
Usually, the patient lies on his stomach and access to the spine is from the back (from dorsal). The surgeon pushes the back muscles aside and can thus stiffen the spinal segments at the spine. In the section that is to be stiffened, titanium screws are inserted into the vertebral bodies and these are then connected with a rod.
The screw connection immobilizes the affected section. In many cases, the discs between the vertebrae are also removed and replaced by so-called cages.These are placeholders made of plastic or titanium that are implanted and grow together with the adjacent vertebrae over time. Although spondylodesis is a serious procedure, the operation is associated with relatively few complications.
Are you more interested in this topic? You can find detailed information on this topic at Surgical principles in spondylodesis There are several surgical techniques for stiffening the spine in a spondylodesis operation. The most common methods are In PLIF, the operation is performed from behind (posterior) via the patient’s back.
The back muscles are pushed aside and the intervertebral disc between the vertebrae is replaced by an implant (cage). Two screws are then inserted into the vertebral body and the vertebrae are connected to each other with a rod. With TLIF, similar to PLIF, the patient is operated on through the back, but the procedure is performed more to the side of the spinal canal.
The spinal canal does not have to be cut open, as the implant can be inserted via the intervertebral hole. As a result, the musculature is only minimally injured and the procedure is less traumatic. The ALIF procedure is similar, but here the procedure is performed from the front (anterior).
The surgeon makes an incision in the middle or laterally in the lower abdominal region to reach the vertebrae in the lumbar region. The intervertebral discs are removed, the implant is inserted and the vertebral bodies are fused.
- PLIF (Posterior Lumbar Interbody Fusion),
- TLIF (Transforaminal Lumbar Interbody Fusion) and
- ALIF (Anterior Lumbar Interbody Fusion).
Spondylodesis can be performed either from the front (ventral), from the back (dorsal) or from both sides (ventrodorsal).
Ventrodorsal spondylodesis is a special surgical technique in which the vertebral bodies are connected via two separate accesses from the front and back. The back is opened and the muscles are pushed aside. The vertebral bodies are then connected to each other with screws, rods and plates.
The abdominal cavity is opened up at the front via a second access and the intervertebral discs between the vertebrae are removed from the ventral side. An implant (cages) is then inserted. A spondylodesis can be performed either on the cervical spine (cervical spine) or on the lumbar spine (lumbar spine).
A stiffening of the cervical spine is usually performed from the front (ventral). This involves exposing the vertebral bodies either via a longitudinal access (longitudinal section) along a cervical muscle (the sternocleidomastoid muscle) or via a transverse access (cross-section). The intervertebral disc is then removed and a cage containing autologous bone fragments is inserted between the vertebrae to be stiffened.
The vertebral bodies are additionally connected with each other by plates and screws. After the operation, the spaces between the fixed vertebrae ossify and the operated section stiffens. Access to the stiffened spinal column in the lumbar spine region is either from behind (dorsal), from the front (ventral) or from the side (lateral).
In most cases, the patient lies on his or her stomach and the operation is performed from behind over the back. The back muscles are pushed away laterally, thus exposing the spinal column. Then the intervertebral discs are removed, replaced by implants and the vertebral bodies are screwed together.
After the operation, patients must wear a lumbar corset for several weeks. The corset supports the spinal column and accelerates the ossification process of the vertebrae. The patient is put under general anesthesia during the spondylodesis. The duration of the operation depends on how many vertebral bodies are joined together and which surgical technique the surgeons have chosen. Usually the procedure takes between three and five hours.
