There may be some evidence that fusing one segment of the spine may put extra stress at other levels of the spine. This is the main reason that spinal surgeons attempt to limit the amount of levels that they fuse to the levels that are the ones causing the problem. It then will be necessary to follow the patient over a long period of time to make certain that there are not any areas of adjacent level deterioration. The percentage chance of another level degenerating is a subject of some study now in the medical research literature and it is not clear whether or not this adjacent level deterioration is a natural process of aging or if it is truly related to the need for the performance of a fusion.
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What most spine surgeons feel is that by fusing a segment of the spine, you do stress the levels of the spine above and below the fusion, and most will say yes that does contribute to perhaps further future degeneration of the levels of below and above. Now on the other hand, the patient's spine obviously has already been pre-disposed for degeneration. So perhaps the degeneration above and below would have happened anyway. But I think most spine surgeons, again think or believe that there is an added stress to the levels above and below the fusion.
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Not usually, but sometimes the fusion may need extending.
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That is an excellent question. In a single-level fusion, there is little impact on the spine. In a multilevel fusion, the major concern is adjacent-segment degeneration. Discs act as shock absorbers between the vertebrae. When the spine is fused, the discs above or below the fusion may absorb the sheer force from everyday motion, and thus wear out. When fusion is performed it is essential that spinal balance is maintained. If this is done, the adjacent segments are at less risk of degeneration.
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When we are doing a fusion we are taking care of problems that are existent at one level. Now when you have a fusion done, it does put a little more stress on those adjacent levels. Some medical studies say that the risk is not any greater, than the risk of developing problems independently of that fusion.
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The answer to this question, unfortunately, remains unanswered. Fusion surgery does not directly harm adjacent areas of the spine. It is a very focused operation that is targeted at the specific vertebral levels being fused. Great care is taken to avoid damaging the uninvolved spinal levels. However, as the patient ages, spinal levels above or below the fusion may degenerate. Some studies indicate that this may be caused by the same factors that caused the original level to break down. Genetics, trauma, smoking or aging are all contributing factors. Other studies have shown that fusing one level puts additional stress on adjacent levels. This added mechanical stress could accelerate degeneration of adjacent levels. These levels are approached in the same manner that the original one was treated.
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There is consistent data that shows that, after a fusion of a particular vertebral segment in the lumbar spine, the levels above and below that fusion will sustain additional stress and may develop early degenerative changes - wear and tear on the discs, osteophyte formation, and some signs of instability.
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The answer is still unknown. The problem is that most people will develop degenerative disc disease over time. When a patient who had a fusion presents years later with a disc problem, how do we decide if that problem is caused by the fusion, or caused by the normal aging process. If fusions do cause adjacent disc problems, it is not common, and usually occurs later. Moreover, continuing with a proper exercise problem may help diminish this risk. It would be foolish to decide against a fusion and live with severe pain for many years just to avoid a possibility of needing more treatment later on.
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There is probably a small increased risk of wearing out spinal segments adjacent to a fusion. This risk is generally small, but must always be considered when proposing a spinal fusion.
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A risk that is involved in lumbar fusion is that the adjacent levels to the fusion may also become a problem. That level may require surgery as a possible treatment.
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Fusing the spine causes increased work loads on the adjacent segments of the spine. This can lead to increased wear and tear and early degeneration. This may or may not become symptomatic in the future.
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In general, if the spine is healthy, then a fusion does not have a significant effect on the spine. If however, there is a significant adjacent level disease, then surgery of the spine might increase the rate of degeneration of these other levels. Therefore my recommendation is to treat all the affected levels.
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If one segment of the spine is fused it is generally assumed that adjacent levels will over time undergo more rapid degeneration due to the additional stresses imposed. It is unclear how this relates to the development of symptoms or the subsequent need for additional surgery. Several studies have shown less than 10% of patients will need additional surgery attributed to the performance of a fusion at an adjacent level.
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Fusing the spine can lead to increased pressure on the normal levels above and below the fused area. However, newer technology is available to minimize this risk. Your spinal surgeon will discuss with you the risks of fusion versus this newer technology, such as disc replacement or stabilization, without fusion.
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Fusing the spine does increase the stress seen by the adjacent disks and joints. Whether this added stress translates into a new source of pain or instability is harder to predict. About 1 person in 5 will have adjacent level pain that is bad enough to need surgical treatment.
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If the adjacent discs are normal there is no absolute data that has shown that a fusion will lead to the deterioration of adjacent areas. Fusion will place additional stress on the adjacent areas.
Unfortunately, though, patients who have degenerative disc disease may have a predisposition for the other discs to degenerate naturally. If deterioration occurs to the adjacent areas, is caused by the natural progression of the spine degeneration, or is it related to the adjacent fusion or possibly a combination of both? This answer to that question is still uncertain. In my experience however the vast majority of patients with normal discs adjacent to the site of fusion procedure do not have significant deterioration of the adjacent areas.
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Spinal motion is determined by the complex movements between multiple spinal bones (segments). If some of these segments are fused, additional stresses are absorbed, particularly by the adjacent areas of the spine. This could possibly predispose those areas to problems in the future.
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Less than 15% of spinal fusions cause damage to adjacent areas.
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The spine is a multi-segment column. If one set of joints is taken away then the remaining joints must take up that function. It will lead to increase stress on those joints, which may lead to accelerated wear and tear change.
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Usually, the damage to adjacent areas is minimal. A fusion does result in more stress on the unfused levels above and below the fusion. So, if those levels are predisposed to have a problem, it is possible that a fusion may accelerate this problem. As a result, if a fusion is not needed, it is best not to do one; however, if it is clearly indicated, the worries about the affect on the adjacent area should not be a reason not to perform the fusion.
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Spinal fusion does not directly cause damage to the adjacent areas. Over time, however, it is known that a spinal fusion does increase the stress applied to the adjacent joints. This can, over many years' time cause a gradual accelerated degeneration process to occur within those adjacent discs and joints.
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It's possible. Again it depends on the type of implants used, it also depends on the approach.
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There will be more demand for movement on the level above and below those levels that are fused and that can result in wear and tear of those levels. They can degenerate further. However, by learning proper body mechanics through physical therapy and then continuing on with back care modality such as weight control, exercise, chiropractic, physical therapy treatments intermittently one can limit the stresses on the other levels.
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There is a slightly higher risk of spinal degeneration in those levels adjacent to a spinal fusion. Although this risk is low (5%) it should always be taken into account when deciding whether to have a spinal fusion.
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This is certainly possible if the surgical technique of inserting the implants is not performed appropriately. In addition, it is possible, even with appropriate surgical techniques, that fusion devices can lead to premature breakdown of the spine above and below that is not fused.
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In time it will lead to stress and wear.
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The fusion itself does not directly affect the remainder of the spine. However, the spinal dynamics are changed or the ability of the spine to bare weight and loads are altered forever. Therefore, over time with wear and tear on the spine plus arthritis and aging, there are predictable patterns of changes that occur in the spine based on its spinal dynamics. Regardless of spinal fusion, the spine will develop predictable patterns of changes over time for the same reasons. The occurrence of problems are influenced by these spinal dynamics.
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Fusing the spine causes increased work loads on the adjacent segments of the spine. This can lead to increased wear and tear and early degeneration.
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