When is this procedure indicated?
Surgical intervention is recommended in cases of chronic pain, resistant to conservative treatment that causes a marked reduction in quality of life. The purpose of the intervention will be to act on the cause of pain, which is both of mechanical origin and nerve compression-induced. The goals to be achieved in this type of intervention are:
- reduce vertebral slip (when indicated) and stabilize slipped vertebra (bone fusion);
- decompress (directly or indirectly) the nerve elements.
How is it performed?
The intervention is performed under general anesthesia. The standard posterior approach involves fixation of the involved vertebrae by means of special instruments consisting of pedicle screws, intersomatic cage and bars with the application of a bone graft, in order to allow a permanent fusion between the vertebrae of the selected area previously crucified.
Вirect nerve root decompression has to be frequently compbined with it.
Anterior retroperitoneal (ALIF) or lateral (LLIF) approaches in combination with posterior arthrodesis represent alternative minimally invasive techniques that allow optimal correction of the listhesis, less blood loss and early functional recovery.
For an arthodesis operation for one or two vertebral levels, an average stay of 4 days is expected, while respecting the patient's general conditions. At home, the patient will have to wear a semi-rigid brace (cloth and splints) when he/she is with the spine column in load. You should avoid flexion, extension and rotation of the upper body, and should not carry loads or exert physical strain on the spine. Wound management is generally simple, and can also be performed at the patient's home. The first outpatient check-up is 10 days after discharge, during which the stitches are removed, dressing is applied, medical therapy is checked and, if necessary, modified, and advice is given for the continuation of the postoperative course.
A second checkup is normally scheduled about 1 month later with a follow-up x-ray.
At this time, if the patient's clinical and radiographic conditions permit, the brace can be removed and the rehabilitation program can begin.
Subsequent clinical and radiographic outpatient follow-ups are scheduled in 1 year, 2 years, 5 years, and 10 years.
In case of special needs, outpatient checks are scheduled according to specific needs.
Possible risks and side effects related to surgery in general are: bleeding, allergic reactions, infection, deep vein thrombosis (obstruction of a vein), embolism, and skin irregularities around the area of surgery.
The clinical condition immediately following the planned treatment can be expected to be characterized by some sequelae, and in particular: persistence of algic symptoms, hyperpyrexia.
Specific foreseeable risks and complications of the proposed surgery in the short and long term are: neurological injuries (of the nerve roots, dura mater), vascular and pleural injuries, hematoma formation.
Among the complications in the medium-long term is the possibility of a lack of consolidation of the bone graft and, since an instrumentation is used, a breakage or loosening of the implant may occur, which may require a second operation for the partial or total removal of the same.
The factors in this case that make surgery more complex and therefore increase the risks are: advanced age, high degree of slippage, presence of anatomical abnormalities, association of other acquired or congenital morbid conditions, previous surgery at the affected level, presence of scar tissue, obesity, smoking, taking antiplatelet or anticoagulant therapy.