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Most of the vertebrae in the human spine are joined to their immediate neighbours by facet joints. These joints are articulated: they lock the vertebrae together, whilst allowing them to move (an articulated lorry provides a useful analogy).
Abnormal joint motion or instability can result in pain, in which case fusion may be recommended, an operation in which two (or sometimes three) vertebrae are welded together. If successful, the fusion will prevent all motion at the vertebral segment and stabilise it; hence, in theory, the level of pain experienced by the patient should be diminished.
During the operation, the spine is approached either from the front, via the abdomen (an anterior fusion), or directly from behind (a posterior fusion). A bone graft is then taken from the pelvis. Depending on the type of fusion, the bone is either:
Placed across the vertebrae (an external fusion), or In-between the vertebral bodies (an inter-body fusion). This requires the inter-vertebral disc to be removed (the diagram shows an inter-body fusion).
A solid fusion is achieved when the bone graft grows into the vertebrae, usually over a period of three months (during this period, patients are advised to avoid bending, lifting and twisting). Screws, plates and other devices are often used to assist the fusion.
Like other forms of spinal surgery, a fusion is rarely successful in terms of its clinical outcome (if ever); patients are usually worse off after the procedure. The vertebrae are simply not designed to be fused and, as a result, transfer injuries often occur. The original stress and instability is transferred from the fused vertebrae, to those above and below the fusion (it is actually common for the stress to be amplified because the normal range of motion is destroyed).
In addition to this, a solid fusion is by no means guaranteed: non-union rates of between 10% and 40% have been quoted in the medical literature, resulting in a permanent pseudo-arthrosis (a manufactured joint that often degenerates over time). Non-union rates are typically higher for multiple-level fusions (typically involving three vertebrae); other risk factors include smoking, which affects bone formation, and obesity, which places too much stress on the spine.
Finally, a spinal fusion will generate scar tissue and adhesions, often resulting in substantial post-operative pain, debilitation, and other serious, clinical problems.
We strongly advise all of our patients not to undergo spinal surgery.
A fusion may solve the original condition, but the pain will simply transfer to other levels of the spine. This secondary pain is likely to be more intense and, if the fusion fails, the patient will require a second operation. In addition to this, the patient is often left with severe, disabling pain in the pelvic region (the area from which the bone graft is taken), adhesions, leading to severe clinical problems and damage to the spinal nerves. Put simply, the risks are too high.
Instead, we believe the correct approach is to decompress, or mobilise, the spine, by using non invasive techniques, i.e. techniques that are based on Orthopaedic Medicine. In this case, the spine will be decompressed in a safe and reliable manner: the chances of recovery are very high (and we have the success stories to prove it).
To receive non-invasive treatment, you can visit our Spine Clinic. You can also receive a Diagnosis filling the on-line Consultation Form. For those people who can neither afford personal treatment, nor make the trip to London, we recommend that you purchase a Backrack™.For those who wish to understand the risks involved in spinal surgery from people who have already undergone the procedure we recommend that you visit our Spine Guestbook page and/or directly our Patients’ Forum page.
Usually paid by the NHS or private insurance; complications during/after surgery will result in additional cost.