The spine has five sections that includes the cervical (neck) region, the thoracic spine (part that the rib cage attaches to), the lumbar spine (in the small of the back), and the sacrum with the small coccyx (tail bone) attached.
We have discs that are between each vertebra and they act as cushions or shock absorbers. These discs have a liquid filled jelly like centre that tends to dehydrate in our third decade, and beyond, and this can lead to the very common complaint of low back pain, and also neck ache.
The spinal column also carries the spinal cord ('electrical cable') that carries electrical information to and from the brain. At every level in the spinal column there is a pair of nerve roots that branch off the sides of the spinal column and then go on to supply the legs and arms with power and sensory control. If these nerves become compressed by either a herniated (bulging or ruptured) disc and/or a bone spur (present in people with osteoarthritis of the spine), this can cause pain that shoots into the arms (from cervical nerve root compression) or the legs (from lumbar nerve root compression) - also known as 'sciatica'.
There is also a pair of facet joints at each level that are the small joints that link each pair of vertebrae at the back, behind the disc and spinal cord. These can degenerate with age and can be a source of back ache.
Tests to Diagnose Spinal Problems
Most patients with spinal problems present with pain as a significant problem in their history. Other spinal problems relate to a significant change in shape of the spinal column - like a curve in the back, called 'scoliosis'. Scoliosis management is a very large part of Dr Labrom's practice and in many cases, spinal surgery can be avoided.
Clinical History and Examination
This remains a very important part of work up for all spinal problems. Usually, this is enough to have a very good understanding of what is going wrong with the patients back or neck.
These are very useful and simple. They provide a lot of information, especially with regards scoliosis conditions.
Spinal fusion was formerly used primarily for conditions such as scoliosis and other spinal deformities. Today, although most people with chronic low back pain don't need to undergo spinal fusion, it has become increasingly popular for treating low back pain.
Evaluating your suitability
Before you and your doctor agree to surgery as an option, your doctor will want to make sure that you've given nonsurgical treatments a reasonable trial. Also, your doctor may conduct a study called a diskogram, which is a special X-ray examination that involves the use of a dye. The dye, injected into a disk, serves to make it appear better on an X-ray. The injection of dye may also produce a pain similar to your ongoing back pain, which helps your doctor pinpoint that disk as the source of your pain.
What to expect during the procedure
Spinal fusion surgery requires general anesthesia. The procedure may take from two to 12 hours, depending on how extensive the surgery is and the technique your surgeon uses. Surgery may involve a large incision, or may be done using newer techniques with smaller incisions.
To fuse the spine, your doctor needs small pieces of extra bone to fill the space between two vertebrae. This bone may come from your own body (autogenous bone), usually from a pelvic bone. Or, it may come from another person (allograft bone) by way of a bone bank. If the front of your spine is fused, the disk is removed first. Bone graft substitutes, such as genetically engineered proteins, are being developed as alternatives to using bones from your body or a bone bank. Sometimes, doctors also use wires, rods, screws, metal cages or plates. As with any surgery, spinal fusion carries risks, including pain at the donor site for the bone, infection and nerve injury.