Synonyms
Spinal fusion, ventral spondylodesis, dorsal spondylodesis, spinal fusion, spinal fusion surgery, spinal fusion surgery, spinal fusion, segment fusion, back pain, spinal surgery, herniated disc
Definition
The term spondylodesis refers to a surgical therapy in which various implants and techniques are used to achieve a therapeutically desired partial stiffening of the spinal column. Spondylodesis is mainly used to treat wear-related spinal instabilities (spondylolisthesis) and unstable vertebral fractures. Spondylodesis is also used to correct the spine in cases of severe hunchback (kyphosis) or lateral bending (scoliosis). The stiffening caused by spondylodesis is permanent.
Introduction
One of the main causes of back pain is pathological mobility of vertebral bodies among themselves, so-called instabilities. Such instabilities are mainly caused by wear-related spinal diseases (older patients; osteochondrosis), especially of the intervertebral discs, but also by congenital vertebral body malformations (younger patients, spondylolysis). At an advanced age, wear-related intervertebral disc diseases occur more frequently together with other wear-related spinal column diseases (spinal canal stenosis, spondylarthrosis (facet syndrome)).
Such changes can become noticeable by severe local back pain. In advanced cases of disease, the spinal cord and the nerve roots originating from the spinal cord are also involved in the disease process. The spinal cord and the nerve roots are thereby harassed by bone attachments (osteophytes) of the spinal column as well as by intervertebral disc and vertebral ligament components.
If the nerve fibers are too strongly pressed (irritation), the result is typically a progressive neck or back pain in the arms or legs. In the final stage, wear-related narrowing of the spinal canal (spinal canal stenosis) can even cause paralysis of the arms or legs. The task of spinal fusion is now to restore the original stability of the spine and to eliminate bony and soft tissue narrowing.
For whom is spondylodesis necessary?
There are some diseases where spondylodesis of the spine may be necessary. What they all have in common is that, for various reasons, the stability of the spinal column is no longer sufficiently guaranteed. These include: 1. wear-related disc disease Wear-related disc disease (pseudospondylolisthesis) is the most common reason for spondylodesis.
In these cases, it is no longer possible to achieve a therapeutic success through an otherwise restorative operation on the intervertebral discs. Operations on the intervertebral discs, such as those performed in the case of a herniated disc (prolapse), are no longer possible in these cases. Even a disc prosthesis can no longer restore lost spinal stability.
On the contrary, a spinal instability is a contraindication for the installation of a disc prosthesis. Spondylodesis may also be indicated in the context of a persistent painful condition after a preliminary discectomy (post-discectomy syndrome). 2. spondylolysis This clinical picture is more common in younger patients.
A congenital or acquired vertebral arch closure disorder (lysis) results in a slippage of the vertebral body (spondylolisthesis/spondylolisthesis-olisthesis) of the diseased vertebral body over the underlying healthy vertebral body. A common classification of this spondylolisthesis is the Meyerding classification (I-IV). 3. disc and vertebral body infection (spondylodiscitis) In some cases of bacterial disc and vertebral body infection, conservative treatment with antibiotics alone is not sufficient.
Reasons for this can be that the inflammation threatens to spread to the spinal cord and thus threaten the brain or that the stability of the affected vertebral body section is no longer guaranteed due to advanced disc and vertebral body destruction. 4. vertebral body fracture (vertebral body fracture) Due to the development of kyphooplasty/vertebroplasty, many vertebral body fractures, especially those caused by osteoporosis, can nowadays be stabilized by a minimally invasive surgical procedure. Stable, injury-related (traumatic) vertebral body fractures can be treated conservatively in a corset or bodice if necessary.In the case of unstable vertebral body fractures involving the rear edge of the vertebral body that delimits the spinal canal, there is a risk of spinal cord injury with the development of cross-sectional symptoms.
In such cases, the spinal column must be stabilized by spondylodesis. 5 Vertebral body tumor Benign vertebral body tumors or aggressively growing vertebral body tumors or vertebral body metastases (daughter tumors) can weaken a vertebral body to such an extent that a spondylodesis operation may be necessary for stabilization. This stiffening operation may also require a complete vertebral body replacement.
- Wear-related intervertebral disc disease
- (osteochondrosis)
- Spondylolysis (vertebral arch closure disorder)
- Intervertebral disc and vertebral body infection (spondylodiscitis)
- Vertebral body fracture (vertebral body fracture)
- Vertebral body tumor
