WHAT AN OPERATION CAN DO: SPINAL FUSION
This operation is designed to stiffen a section of the spine, in order to prevent an instability such as spondylolisthesis from increasing; to fix a section where movement is painful, such as a degenerated disc giving an abnormal pattern of movement, secondary changes in the facet joints; to stabilise the spine in an area weakened during surgery necessary for the removal of diseased or damaged discs; or encourage healing if the spine is fractured or dislocated.
Most commonly, the operation consists of the laying down of a bone graft to increase the stability of the spine across one, two or three vertebrae. The bone for fusion is usually taken from the hip bone; this leaves no deformity or weakness. Often, metal rods or screws are also inserted to achieve a more rapid, secure fusion.
Spinal fusion is a much more serious operation than discectomy. Until a few years ago, it meant lying in a plaster shell for a month, and in bed for up to three months before being allowed up. Nowadays, however, this is less common. Some surgeons allow patients up after a week or two, provided there is nothing to contraindicate this; a corset may have to be worn. If the bones are fixed together with wires, rods or screws, the patient may be allowed up after seven to ten days, to still allow adequate healing of the ‘soft’ tissue surrounding the spinal column.
The back muscles may take quite a while to recover from the operation and to regain normal strength. The patient will later be given exercises by the physiotherapist to stabilise the spine and strengthen the muscles, and in a few months the patient could be back to full activity. Some patients take a year or more to recover completely. A lot depends on the pathology, the patients’s age and past history of the patient’s lifestyle: the physiotherapist and the occupational therapist will show the way but the patient is still the most important member of the ‘team’.
The social worker at the hospital may be necessary to provide home assistance for the convalescant patient.
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