Fusions and Functionality
December 10, 2019
A research team from South Korea recently conducted a study to evaluate if "long" spinal fusion cases had a significantly different effect on post-operative functionality when compared to "short" fusion cases.
Spinal fusion, also known as spondylodesis or spondylosyndesis, is an orthopedic surgical procedure designed to join two or more vertebrae. The procedure is designed to prevent movement between the affected vertebrae and help strengthen the back.
Spinal fusion can be performed at any level of the spine that joins two or more vertebrae.
Long spinal fusion cases are defined as three or more levels. Short cases, by contrast, are two or fewer levels.
The study was published in the October 15, 2019, edition of Spine.
The objective of this new study was to determine if current systems used to evaluate lumbar spinal disorders are useful for evaluating specific functional disabilities after long lumbar fusion procedures.
Currently, the Oswestry Disability Index is used to measure disability caused by low back pain.
The researchers found that while the ODI is the standard of measurement, it didn't necessarily capture specific functional disabilities that occur after spinal fusion procedures. Particularly, it did not measure lumbar stiffness.
To successfully evaluate changes in specific functional disabilities in relation to the lumbar fusion length, the researchers needed a new way to assess patients. They developed their own index, called the Specific Function Disability Index.
Using the SFDI they developed to assess patients, the researchers looked at data collected from long-fusion patients who experienced discomfort three years after their procedure in comparison with patients who had short-level fusion surgeries.
The data came from 81 patients with three or higher-level lumbar fusion and 70 patients matched by age and sex who had one- or two-level lumbar fusions.
They found that post-operative disability scores were greater in individuals with three or more fused vertebrae than those lower-level fusions.
The researchers noted that these functional disabilities were not present in the patients before their fusion procedures.
Another revelation of the research project was that occupation and lifestyle contributed to specific functional disabilities after long lumbar fusion procedures.
As a result, the study authors caution surgeons to be aware of the potential for specific functional disabilities and provide patients with information about the risks of procedures involving three or more vertebrae.
Being aware of post-operative disability can help surgeons determine fusion length, but there are other ways surgeons can help reduce the risk of complications, too.
One of those ways is through intraoperative neuromonitoring.
Also known as IONM, intraoperative neuromonitoring gives surgeons the chance to see what is happening with a patient while they're on the operating table - instead of discovering complications after surgery.
"If you could prevent a patient from having partial paralysis, numbness, pain or foot drop, why wouldn't you?" said Dr. Faisal R. Jahangiri of AXIS Neuromonitoring in Richardson, Texas.
AXIS is helping surgeons across Texas do just that.
"We are in the operating room during spinal procedures - including fusions - and help alert surgeons when there is a change in nerve activity that could be detrimental to the patient," Jahanigiri said.
Source: RYORTHO. ≥3-LEVEL LUMBAR FUSIONS EQUAL LOWER POST-OP FUNCTIONALITY. 14 November 2019.