Spinal stabilisation procedures are operations to control painful movement of
the spine but without creating a fusion. This operation can be used in conjunction
with a decompression or disc surgery to relieve leg pain. They are similar to
spinal fusions, but the advantage of a stabilisation procedure is the fact that
the spine is not fused. It is thought that a spinal fusion may create increased
stress or strain on the level above or below the fusion leading to premature
degeneration and possible symptoms in the future. Spinal stabilisation cannot
however be used for conditions where the bone itself is badly distorted or fractured.
They are therefore not used for spondylolisthesis, fractures, tumours or corrections
of a spinal deformity.
A spinal stabilisation is achieved by the use of an implant which is fixed to
the spine via a variety of methods. The Dynesys procedure requires the use of
screws down the pedicles into the vertebral body to achieve anchorage points.
The same is true of the Graf technique. Other techniques, such as the Wallis
ligament, put an implant in between the spinous processes of the spine and attach
it via ligaments going round the spinous processes. Other techniques use attachments
via the spinal laminae. The basic concept however remains the same. The idea
is to insert a shock absorbing device which allows the spine to be stabilised
but without a solid fusion. The benefit of this is to prevent increased stresses
and strains above the level treated which tends to occur after spinal fusions.
Some surgeons use a hybrid technique to create a fusion at the area of worst
symptomatology topping off with non fusion technology on areas where there is
a degenerative change in discs, which may become symptomatic in the future if
not stabilised. These stabilisation techniques, therefore, can be used with
intervertebral body cages such as in a spinal fusion. The idea is to use spinal
stabilisation techniques to share the load of a disc which is undergoing degenerative
change and becoming painful. If this load can be shared, then the symptoms from
the discs and the facet joints can hopefully be reduced allowing the patient
to continue a reasonably active life, although the spine will never be one hundred
per cent. Another advantage of spinal stabilisation using pedicle screw fixation
is the ability to treat multiple levels of the spine.
This sort of surgery takes between 1 and a half and 3 hours to perform, depending
upon the complexity and the number of levels being operated upon. It is performed
under a general anaesthetic and the usual hospitalisation time is 7 days. It
will take around 6 weeks to recover from the general effects of the operation,
including the wound ache. During this period the patient will experience increased
tiredness and a reduction in stamina at first.
The risks and complications of such surgery include the anaesthetic itself.
There is a small risk of neurological injury either from the position of the
screws, if they are too close to a nerve, or from moving a nerve out of the
way whilst cages were inserted. There is a small risk of injury to a blood vessel,
particularly if the surgery is carried out anteriorly or via the abdomen. There
is also a risk of infection or deep vein thrombosis; these are guarded against
by the use of anti-biotics and TED stockings.
Surgery for back pain is a controversial issue and is therefore only used in
cases where there is intractable back pain which has not been resolved by non-operative
means over a prolonged period of time. By stabilising an area of the spine,
there is a possibility of increased stress and strain being placed upon the
area above and below the fusion and therefore a possibility of premature degeneration
of this area of the spine. This may not however be the cause of major symptoms.
This tends to be less of a problem with stabilising techniques compared with
To avoid excessive bleeding during and after surgery and excessive post operative
bleeding it is important to avoid anything that reduces clotting or thins the
blood. This list includes Warfarin, anti-inflammatories, herbal remedies and
aspirin. These should be stopped seven days before admission.
Clearly medication taken for cardiac reasons is important and so arrangements
would have to be made to reduce these with the advice of your cardiologist.
HRT should also be stopped about two weeks before surgery.
All patients will have a pre-operative assessment at the hospital where their
surgery will be performed. Pre-operative tests such as blood counts and cross
matching, chest x-rays and electrocardiograms may be carried out at these assessments.
Elderly patients or patients with other medical problems will also be seen in
the Anaesthetic Clinic and the anaesthetist will take them through the anaesthetic
process. The purpose of all this is to reduce the risks as far as possible.
When in hospital you will be assessed by nurses and physiotherapists to guide
you through what you can expect. There will be a lot of paperwork including
filling out a consent form for the procedure to be performed.