Choosing before Fusing: Alternate Surgery Possible for Degenerative Spine SlippageTalks about when to fuse the spine are ongoing among doctors. This is especially true for patients with a condition called spondylolisthesis. This problem occurs when a vertebral bone in the spine slips forward over the one below it.
Spondylolisthesis narrows the opening of the spinal canal. This is called spinal stenosis. This in turn may put pressure on the spinal cord and spinal nerves.
Surgery may be needed to take the pressure off the spinal cord and nerves. How much and what to do isn't clear. The standard operation is to remove part of the ring of bone around the spinal cord. The disc between the bones may also be removed. The final step is to fuse the vertebrae together. This will prevent any further movement or slippage in the problem area of the spine.
According to the authors of a study in Germany, fusion may not always be needed. Taking pressure off the spinal cord may be all that's needed. This is true when the spine is stable, and there isn't any extra motion where the spondylolisthesis is located.
Taking the pressure off the spinal cord and spinal nerves without fusing the bones may be the best approach. The authors suggest this for older adults with spondylolisthesis. There are fewer problems after the operation without fusion.
Each decision must be made on a case-by-case basis. First, treatment without surgery is tried. When surgery is needed, only the smallest amount of bone is removed from around the spinal canal to take pressure off the spinal cord. Fusion is best when there is pain and extra motion in the spine at the level where one vertebra is slipping over the one below it.
Rudolf A. Kristof, MD, et al. Degenerative Lumbar Spondylolisthesis-Induced Radicular Compression: Nonfusion-Related Decompression in Selected Patients without Hypermobility on Flexion-Extension Radiographs. In Journal of Neurosurgery: Spine. October 2002. Vol. 97. No. 3. Pp. 281-286.
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