Is Spinal Fusion the Right Option?
Fusion surgery has become a common treatment for certain spine conditions. Most conditions can be and should be treated without a fusion. Other conditions have been shown to have better results with a fusion. How does a surgeon decide to recommend a fusion? This should be based on a patients symptoms and diagnosis but also on the options available to treat the patient. The simplest option is to not perform a fusion.
The question is whether the surgeon has the skills to help the patient but not add to the instability and require a fusion. Endoscopic spinal surgery has the potential to change when a fusion is needed by providing a different way to manage the nerve compression. When these other non-fusion options are not available and cant fix the problem then fusion options become necessary.
Multiple fusion options exist with pros and cons associated with each option. The cons associated with a bigger more complex surgery exist whether it is a fusion or larger decompressive procedure. Larger surgical procedures are associated with more soft tissue injury related to the surgery. Fusion surgery typically involves a larger skin incision and more muscle retraction (which may lead to muscle damage, weakness and pain) and bone removal (which may increase spinal instability rather then improve it). This collateral tissue damage from the surgery may result in more pain, weakness, instability and scar tissue leading to future difficulties. This has led to research and development of new treatments for back pain.
Endoscopic Surgery for Faster Healing and Less Pain
One of the most exciting new spinal treatments is endoscopic spine surgery. Endoscopic spine surgery is done through a very small tube placed between back muscles to reduce muscle retraction and damage. A micro video camera is inserted to the damaged area to fix the spine under direct visualization. This was initially done to treat disk and facet disease but now is being used for fusion surgery.
Endoscopic fusion or more appropriately, Endoscopic Interbody Fusion (ELIF), is a spinal fusion surgery done under direct endoscopic visualization. The endoscope provides visualization of the surgical site in the disk space not possible even with a microscope. Endoscopic fusion may be done as same day surgery. People may have less blood loss, less pain and faster recover and return to work then traditional open fusion surgery.