Spinal Balance
and Adjacent Segment Degeneration
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Spinal
balance is critical |
 Balance
is absolutely critical in spine surgery. The delineation
between good and excellent surgery may depend on how
well the surgeon balances the spine during the reconstruction.
A spine which is decompensated or
tilted forward, will require increased energy utilization
by the various muscles which support the head, the
neck, and the rest of the spine. A spine which is out
of alignment and pitched forward will require various
back, buttock, and leg muscles to "right the spine" during
activities such as sitting and walking. This increased
energy requirement may cause the muscles to become
easily fatigued which may in fact cause pain. Reconstruction
surgery which reduces the normal curvature of the spine
of the lumbar spine (flatback
syndrome ) may in fact leave a patient more
vulnerable for symptoms than prior to reconstruction. |
Adjacent
Segment Degeneration |
The main
concerns patient's express about a spinal fusion are
loss of motion and the possibility of adjacent segment
degeneration.
The lumbar spine has a small range of motion, approximately 7 degrees,
and the majority of movement in bending comes from the hips and hamstrings.
The discs act as shock absorbers between the vertebral bodies. When a
disc is replaced with a boney fusion, the disc above a fusion (adjacent
level) absorbs more of the wear and tear of daily activities. The key
variable in minimizing degeneration of adjacent levels is alignment of
the fusion. |
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The surgical options for spinal instability are Anterior Spinal Fusion,
Posterior Spinal Fusion, or Anterior and Posterior Spinal Fusion. I
believe an anterior release and interbody spinal fusion, followed by
posterior instrumentation is the best way to realign the spine and
create lumbar lordosis. The key to a long-term successful outcome is
spinal alignment. |
Choosing
a surgeon |
When choosing
a surgeon for any sort of spinal reconstruction, it is
absolutely critical that the question of balance be raised.
Although various techniques may seem state-of-the-art
or minimally invasive any technique which does not attempt
to recreate normal spinal balance may have long lasting
negative or adverse results on the patient's spine health.
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Related
links:
Flatback Syndrome
Flatback surgical
cases performed by Dr. Pashman
"Flatback
Deformity" written by Dr. Pashman
Anterior Spinal Fusion
Posterior Spinal Fusion
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