Spinal Fusion Treatment Cost in India

Spinal fusion is surgery to connect two or more vertebrae in your spine permanently, preventing contact between them.It aims to prevent the motion in any painful vertebral segment which further acts in decreasing the generated pain from the joint. There are quite a few approaches to lumbar spinal fusion surgery and will involve the following techniques:

• To the segment of the spine, a bone graft is added
• Setting up of biological responses that will act as a catalyst for the growth of the bone graft between the two vertebral elements and creates a bone fusion
• The bony fusion that allows one fixed bone to replace a mobile joint stops the motion at that joint segment.

In the spine at each level, there is a paired facet joint in the back and there is a disc space in the front. Working together, these structures will define a motion segment and allow motions in multiple degrees.

At one segment, two vertebral segments are required to be fused together to stop the motion. Suppose considering the lumbar region, L4-L5 (lumbar segment 4 and lumbar segment 5) spinal fusion is taking place only at one level. The fusion will be called a 2-level spinal fusion if it involves L4-L5, L-S1 fusion.

When a spinal fusion surgery makes use of bone graft, it causes the two vertebral bodies to grow simultaneously and finally transform into a long bone. The graft for bone can be taken from the hip of the patient, called an autograft bone during the fusion surgery or it can be collected and harvested from the cadaver bone or allograft bone and can be manufactured as a synthetic bone graft substitute.

In most of the cases, lumbar spinal fusion surgery is considered to be the most effective for those conditions which require only one vertebral segment fusion. Most patients will never notice any limitation in motion after one-level spinal fusion surgery.

Two levels of spine fusion surgery have become a reasonable option for the treatment of severe pain. Spinal fusion where more than two levels of fusion take place will unlikely provide any relief since there is too much pressure on the remaining joints while the normal motion in the lower back is restricted.

For lumbar deformity and scoliosis, 3 or more levels of spinal fusion are considered.

For patients with the following conditions, any abnormal and extra motion at a vertebral segment can result in extreme pain and the inability to function properly and for the spinal fusion is considered. The following conditions will require spinal fusion surgery:

• Lumbar degenerative disc disease
• Lumbar Spondylolisthesis or ischemic, postlaminectomy spondylolisthesis

Other kinds of conditions that may be treated by a spinal fusion surgery can include a weak or a very unstable spine because of tumors, infection, fractures, deformities like scoliosis.

There are many kinds of spinal fusion surgery techniques involved which are being discussed below:

Posterolateral gutter fusion: In this kind of surgery the surgical approach to the spine is via back through a midline incision whose length can vary from three to six inches long.

First and foremost, the bone graft is obtained from the iliac crest in the pelvis and although some form of bone graft substitute may also be employed. The spine surgeons work through the same incision for obtaining the bone graft for performing a spinal fusion.

After this, the harvested graft of the bone is laid out in the posterolateral portion in the spine This region is very vascular in nature and lies outside the spine and is important since the fusion needs a supply of blood carrying nutrients for its growth.

A small extension of the vertebral body called the transverse process in the region is like a bone that acts as a muscle attachment region. The muscles that are attached to the transverse process is elevated for the creation of a bed for laying the bone graft. After this, the back muscles are laid back over the bone graft creating tension for holding the bone graft in its place.

Posterior Lumbar Interbody fusion: Unlike the above procedure, in this procedure spinal fusion is achieved by insertion of allograft bone made like a cage in the lower back or it can be a synthetic material called PEEK or Titanium into the disc space directly. Since the surgical approach is happening from the backside hence it is called a posterior lumbar interbody fusion. It can also be supplemented with simultaneous posterolateral spine fusion surgery.

Anterior Lumbar interbody fusion: This technique was applied for the first time for degenerative spine conditions. This procedure became popular due to the advent of new threaded cages that could hold the vertebral disc in its space better and it allowed for a higher rate of fusion.

This procedure is often clubbed up with anterior or posterior fusions due to the need for providing more rigid fixation than an anterior approach alone can provide. In patients who do not have too much of instability trouble, the above technique will suffice like one-level degenerative disc disease where there are collapses happening in a lot many disc spaces.

Anterior/posterior spinal fusion: This procedure is useful for patients who have high degrees of spinal instability like a fracture or may require a revision surgery if the initial fusion setup was wrong, although there are spine surgeons who prefer this surgery as a primary spinal fusion technique. Fusing both back and front can provide higher stability for the spine and the larger surface area for the fusion of the bone to occur. Both sides of the spine are approached allowed aggressive reduction in patients who suffer from lower back deformities like isthmic spondylolisthesis.

Most of the time the front approach is done first by the removal of the disc material and then cutting the anterior longitudinal ligament which lies in front of the disc space. The spinal segment is released and permits complete reduction. After the anterior and posterior spinal implants are inserted this section grows more stable than even a healthy spine segment.

Transforaminal Lumbar interbody fusion: This surgery is done from the posterior part of the spine. The surgical hardware is first applied to the spine to help in the process of the rate of fusion. Pedicles screws and rods will be attached to vertebra’s back and interbody fusion spacer will be inserted into the disc space from any one side of the spine. Thereafter the bone graft is placed into the interbody space and this will be alongside the vertebra’s back which has to be fused. From the pelvis bone graft is secured and although the bone graft substitutes can be used at times. One long bone is formed as the bone graft heals gradually and it fuses the vertebra above and from below as well.

Extreme lateral interbody fusion: This approach for spinal fusion procedure involves accessing the intervertebral disc space and fusing the lumbar or lower spine. The access is from the side or lateral access. This procedure is recommended by the surgeon if any specific kinds of lumbar spinal disorders have to be corrected like lumbar degenerative disc disease, scoliosis or deformity, spondylolisthesis and lumbar disc herniations that are recurrent in nature or any kind of lumbar stenosis.

The above cannot be used for the treatment of lumbar conditions for which the spinal fusion treatment is an option. For example, problems in the lowest level of the spine like L5-S1 or L4-L5 cannot be treated with this.

This is a minimally invasive type of spine surgery and is designed for accomplishing the following advantages like

• Minimal tissue damage
• Small incision and scar formation
• Minimal loss of blood
• Minimal postoperative discomfort
• Relatively quick recovery time and return to normal functions

In this procedure, the disc in the front of the spine gets removed and gets replaced with an implant that houses a bone graft to make way for a condition where the two vertebrae fuse as one and through the space of the disc.

A few important steps are to be kept in mind while undergoing spine surgery since it will aid in the recovery of the process. Like it is very important to lose a bit of weight if one is overweight and right before the surgery day patient should ensure that they keep moving around. Apart from this medical history should be shared with the healthcare providers in detail so that they can prescribe medications if required before the surgery or recommend stopping the one that can prove harmful.

Some other options may be IDET or Intradiscal electrothermal coagulation or annulation of spinal fusion surgery.  A needle is inserted into the lumbar disc area in this process, and a catheter is pushed through the needle, and the annulus is covered. The heat is said to compress and thicken the fibers of collagen in the disk wall. It shuts down debilitating tears and reduces pain and fractures. It also cauterizes the ends of the nerves to further reduce damage.