>> So spinal fusion surgery is
the treatment of pathologies that include
degenerative disc disease or instability of the spine
that could be trauma from an infection
or just routine degeneration.
Fusion implies the marrying
or sticking together of two bones or more,
in cases of scoliosis for instance.
So the actual active fusion
is fixating and immobilizing the spine,
usually done with screws,
and then laying bone graft down to effect a fusion.
If you think of the screws and rods like rebar
and the bone that we lay down like cement,
it's shoring up an area of the spine which is unstable.
The good candidates for spinal fusion surgery
are those that have instability of the spine,
have scoliosis of the spine,
have some type of curvature or problem of the spine
that cannot be corrected with bracing
to other conservative measures.
These are big operations
and usually the pathology is
something that has gone on over a period of time
when we speak of a degenerative problem.
Patients who do have slippage
or spondylosis, as it's called, or scoliosis of the spine
are the more common patients that are treated
with fusion surgery in the lumbar spine.
Various amount of techniques that we use include
the placement of pedicle screws, rods.
In some cases we can do a fusion
without putting instrumentation in
although, we've shied away from that over time
because we were realizing that
in a lot of cases when there is instability
that we need immediate fixation,
and that's usually done with the placement of hardware.
But there are a variety of types
of hardware interventions that we can do.
Those have to be tailored to the patient,
to their expectations,
and to what type of pathology they have
to try to pick the best solution for each patient.
Image-guided surgery is the ability to take
a medical image, whether it's an x-ray or CAT Scan,
and in real time get feedback
about where the patient is in space.
So I can take a probe actually
and touch the patient's spine,
and see where I am in three dimensions.
Having that ability, like having a magic wand,
allows me to see through normal anatomy
into the end point of where I want
a piece of hardware to go.
So when placing pedicle screws, for instance, in the spine,
the usage of image guidance allows me to,
with pinpoint accuracy,
choose the trajectory best for that patient
to place the screw.
Good outcomes in spinal surgery really is a partnership.
It's a partnership between the physician and the patient.
It's a partnership which starts with managing expectations.
What are you going to expect with surgery?
Why are we doing this surgery?
Having a clear understanding what are goals are for surgery.
Obviously, as a surgeon my goal is to restore function
and to get patients to have less pain
and to improve their quality of life.
That is done from the very first visit
through the very last visit,
in an on-going process
where we make a correct diagnosis for that patient,
agree upon a treatment plan which is best for that patient,
educate the patient as to what they're going to expect,
what limitations they'll have immediately after surgery,
then ultimately, how do we rehabilitate that patient
after surgery to get them back to enjoying life.
One of the biggest things that I see
are patients that come to me who aren't able to do things.
I can't golf.
I can't walk.
I can't do this or do that.
And setting those, taking those limitations
and effecting a treatment plan with rehabilitation,
restoring that patient's ability to do
the things that they enjoy doing.