Instrumentation

Removing Pedicle Screws After Lumbar Spine Fusion

Ben Parr — Sun, 01 Mar 2009 16:13:49 -0800

A physician answers patient questions about removing pedicle screws after back surgery.

Question: Can pedicle screws cause problems in the spine later on?

I had an L5-S1 lumbar fusion in with the pedicle screws and rods. My surgery was successful and now my x-rays show complete fusion. I play competitive sports (ultimate Frisbee, which involves diving on the ground to catch the disc) and have resumed full activity for the past few years. I'm now 34.

Goals of Posterior Motion Preservation Devices

Ben Parr — Wed, 21 Jan 2009 09:13:53 -0800

It is thought by some physicians that the clinical requirements of an ideal posterior motion preservation device include:

A minimally invasive procedure
Preservation or re-establishment of normal motion of the spine
Avoidance of fatigue failure of the device
Maintenance of normal resting posture of the spine without excessive kyphosis (upper spine curve) or lordosis (lower spine curve)
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Rod

spine-health — Fri, 04 Jan 2008 07:53:43 -0800

Definition

Powered Surgical Instruments

spine-health — Fri, 04 Jan 2008 07:53:34 -0800

Definition

Internal Fixation

spine-health — Fri, 04 Jan 2008 07:53:00 -0800

Definition

Immobilization of the spine (usually with implants such as metallic screws and rods/plates, or interbody cages). Internal fixation serves to immobilize the spine while the bony bridge heals across the two vertebrae.

Metal fixation of the spine is considered a temporary splint to the spine to hold it while it fuses. If it fails to fuse(pseudoarthrosis) the metal can fatigue from the continued motion and may eventually break, pullout or loosen.

Harrington Rod

spine-health — Fri, 04 Jan 2008 07:52:56 -0800

Definition

Harrington rod is a surgical implant used to stretch the spine in order to correct abnormal curvature. The rod is attached to the spine with hooks inserted into the vertebra at the top of the curve and the vertebra at the bottom of the curve.

The Harrington rod has a ratcheting mechanism that works to straighten the spinal curve and stabilize the spine. The vertebrae in between the hooks are then allowed to fuse.

Endoscope

spine-health — Fri, 04 Jan 2008 07:52:47 -0800

Definition

An endoscope is a tube-shaped surgical instrument equipped with a light and camera lens in order to view an internal cavity of the body. The use of an endoscope during surgery allows operations to be done through several one-inch incisions to view the involved tissue and operative site with less disturbance to body.

Back surgeons may employ endoscopes when implanting minimally invasive spine fusion systems, interbody cages for spine fusion and for anterior lumbar interbody fusion.

Bone Plate

spine-health — Fri, 04 Jan 2008 07:52:23 -0800

Definition

A bone plate is a thin metal implant used to immobilize bone segments. The plate is affixed with screws to properly align the bone and aid in the healing process.

In spine surgery, a bone plate may be used to help stabilize the fused area and prevent dislodgement of the bone graft. It is used most commonly in cervical fusion surgery (in the neck).

Synonyms and relevant terms

Cortical Bone
Cervical Fusion
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Intrathecal Pump Implant Video

spine-health — Thu, 03 Jan 2008 11:19:41 -0800

An intrathecal pump works to relieve chronic pain by inserting small amounts of medicine directly into the intrathecal space (area surrounding the spinal cord) to prevent pain signals from being perceived by the brain. This video gives a clear picture of an intrathecal pump implant.

Rechargeable Spinal Cord Stimulators for Chronic Pain (Research Article)

spine-health — Mon, 17 Dec 2007 08:55:42 -0800

Back pain relief – overview of neurostimulators

Spinal cord stimulators are battery-powered electronic devices enclosed in a small metal container that are surgically implanted under the patient’s skin in the low back area. They send low levels of electrical energy to nerve fibers with the goal of preventing pain signals from reaching the brain. Depending on the patient, the pain is to some degree replaced with a feeling that is often described as a tingling or warm sensation.

Additional Treatments

spine-health — Mon, 17 Dec 2007 08:55:41 -0800

Transcutaneous electrical nerve stimulation, or TENS unit (also called electrotherapy), involves placing an external device over the skin that applies low-voltage electricity via electrodes. Generally, TENS units are applied for moderate to moderately severe acute to subacute pain, and for some people they may be effective for chronic pain as well.

Transcutaneous Electrical Nerve Stimulators (TENS)

spine-health — Mon, 17 Dec 2007 08:55:41 -0800

The patient may use a TENS unit at home for back pain relief on a long-term basis. TENS units are about the size of a pack of cigarettes and typically cost $250 - $700. All units allow the user to adjust the intensity of the stimulation; some units also allow the user to select high-frequency stimulation (60 - 200 Hz) or low-frequency stimulation (<10 Hz).

Spinal Cord Stimulators and Pain Pumps - Implantable Systems for Neuropathy

spine-health — Mon, 17 Dec 2007 08:55:41 -0800

Advanced treatments for neuropathic pain (neuropathy)

When oral medications and/or nerve blocks do not sufficiently control the pain, advanced pain therapies or implantable systems may be effective for treating neuropathy. These systems are designed to interrupt transmission of pain signals from the spinal cord to the brain. If the neuropathic pain signals do not reach the brain, then the patient does not actually feel the pain.

Posterior Motion Preservation Spine Surgery: Alternative to Spinal Fusion

spine-health — Wed, 12 Dec 2007 00:21:07 -0800

Motion preservation

There are a wide variety of posterior motion preservation devices in various stages of development and clinical investigation.

Interspinous Process Spacers

spine-health — Wed, 12 Dec 2007 00:21:07 -0800

As seen in Figure 1 the spinous processes are located in the very back of the spinal column near the skin surface. In fact, by passing the hand down the center of the low back one is usually able to feel several small prominences. These are the spinous processes.

Review of Current Minimally Invasive Spine Fusion Systems

spine-health — Wed, 12 Dec 2007 00:21:07 -0800

The following is a review of three types of minimally invasive systems currently used in the US for performing a spine fusion surgery with pedicle screw fixation.

Electrical Stimulation for Spinal Fusion

spine-health — Wed, 12 Dec 2007 00:21:06 -0800

Introduction to electrical stimulation

The use of electrical stimulation to improve the effectiveness of lumbar spinal fusion has grown significantly over the past decade. As the number of scientific and clinical studies validating the use of electrical stimulation to enhance spine fusion has increased, there is a better understanding among spine surgeons about how and when to use specific electrical stimulation devices.

Minimally Invasive Spine Fusion Systems

spine-health — Wed, 12 Dec 2007 00:21:06 -0800

Spinal fusion technologies

Much of the published minimally invasive spine surgery techniques today describe less invasive methods of performing a spinal fusion with pedicle screw instrumentation. This article will review the major developments in minimally invasive surgery systems for posterolateral fusion and pedicle screw fixation.

New Bone Growth Stimulation Devices for Spine Fusion

spine-health — Wed, 12 Dec 2007 00:21:06 -0800

More recently, two other non-invasive technologies—external bone growth stimulators—have been approved for use as an adjunct to improving the success for spinal fusion. Much like the pulsed electromagnetic field (PEMFs) device, the capacitive coupling (CC) and combined magnetic field (CMF) devices are worn externally, and are used for up to nine months after the spine fusion surgery.

How an Electrical Bone Growth Stimulator Helps with Spine Fusion

spine-health — Wed, 12 Dec 2007 00:21:05 -0800

Electrical bone growth stimulators are a supplemental form of therapy to help enhance the body’s bone healing process … a process that is absolutely essential for the success of any type of spinal fusion surgery.

External Bone Growth Stimulators for Spine Fusion

spine-health — Wed, 12 Dec 2007 00:21:05 -0800

Devices used for bone growth after spine fusion

External bone growth stimulation devices are worn outside the skin and do not require surgical implantation or extraction. Typically, the device is worn after spine fusion either as:

Small, thin skin pads/electrodes that are placed directly over the fusion site and deliver a type of electrical stimulation called Capacitive Coupling (CC), or;
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Internal Bone Growth Stimulators for Spine Fusion

spine-health — Wed, 12 Dec 2007 00:21:05 -0800

Implantation of bone growth stimulators for spine fusion

An internal bone growth stimulator is implanted at the time of the spinal fusion surgery. This device is quite small and is implanted in a soft pocket of tissue under the skin in the lower back to the side of spine. It delivers small electrical currents directly to the area in the spine where bone growth (the spine fusion) is to occur (see Figure 1).

Exercise Ball Precautions

spine-health — Wed, 12 Dec 2007 00:18:35 -0800

More Physical Therapy Info

Exercise Ball Therapy

Physical Therapy Benefits

Rehabilitation and Exercise

Core Strength Exercises

What is Physiatry?

Spine Fusion Instrumentation

spine-health — Wed, 12 Dec 2007 00:03:19 -0800

The role of spine fusion instrumentation is to provide additional spinal stability while helping the fusion set up.

Various forms of instrumentation (medical devices) have been developed with the goal of improving the rates of successful spinal fusion. Because bone tends to fuse more effectively in an environment where there is little motion, instrumentation helps the fusion set up by limiting the motion at the fused segment.

Lumbar Spine Surgery

spine-health — Wed, 12 Dec 2007 00:03:18 -0800

Two general types of lumbar spine surgery comprise the most common surgical procedures for the lower back: decompression and spinal fusion.

Decompression surgery involves removing a small portion of the bone over the nerve root and/or disc material from under the nerve root to relieve pinching of the nerve and provide more room for the nerve to heal (a microdiscectomy or laminectomy).
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Interbody Cages for Spine Fusion

spine-health — Wed, 12 Dec 2007 00:03:18 -0800

In September of 1996, the FDA approved anterior interbody cages for use in the disc space, providing a new technique that allows the spine to be fused with less morbidity (e.g. less post-operative discomfort) than in the past.

Pedicle Screws for Spine Fusion

spine-health — Wed, 12 Dec 2007 00:03:18 -0800

The pedicle screw, which is sometimes used as an adjunct to spinal fusion surgery, provides a means of gripping a spinal segment. The screws themselves do not fixate the spinal segment, but act as firm anchor points that can then be connected with a rod.

Cervical Spinal Instrumentation

spine-health — Wed, 12 Dec 2007 00:03:18 -0800

Cervical spinal instrumentation is often used to help provide considerable stability for the spine after surgery.

Common types of instrumentation include:

Anterior cervical plates
Posterior cervical plates
Posterior cervical wiring
Anterior cervical interbody cages
Post-operative cervical braces
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What Is the Make-Up of Artificial Discs?

spine-health — Wed, 12 Dec 2007 00:00:22 -0800

In general, there are several types of artificial discs:

Total disc prosthesis – designed to replace a full disc
Nuclear prosthesis – designed to replace the soft inner core of a disc.

These artificial discs are manufactured using man-made materials, such as:

Metal part of the disc
Rubber polyethylene of a hidrosel for the soft inner core.
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