What Are Spinal Implants?

Every year, people miss nearly 150 million days of work as a result of chronic lower back pain. It’s estimated that back pain affects about 80 percent of adults at some point in their lives. About 25 percent of adults reported feeling back pain at some time in the past three months.

Usually, treating back pain involves physical therapy, medications and exercise. But in more severe cases, surgery and the placement of spinal implants might be necessary. Spinal implants aren’t the right choice for everyone with back pain, but they can be an ideal option for some.

What Spinal Implants Do

Spinal implants have several roles to play, both during spinal fusion surgery and without it. What spinal implants do depends in large part on the type of implant they are and the group they belong to. Generally speaking, implants can help:

• Facilitate the fusion of two vertebrae
• Improve stability of the spine
• Strengthen the spine
• Correct any deformities

Why You Might Need Spinal Implants

Spinal implants are often used as a part of spinal fusion surgery. The implants help to hold the vertebrae in place while your spine heals from the surgery. Although surgery is usually the last resort for people with back pain, there are specific cases when it might be the best option.

• • Arthritis of the Spine: Severe cases of arthritis in the spine can lead to a considerable amount of movement between two vertebrae, making the spine unstable. The instability can cause a person to experience feelings of weakness in the legs and arms, as well as pain in the lower back and limbs. If left to progress, the condition can cause spinal stenosis or a narrowing of the spinal canal.

• • Scoliosis and Other Deformities of the Spine: Scoliosis develops when the spine curves sideways. It often occurs in the early stages of puberty and is most commonly very mild. There are cases where the curve is very distinct, which can lead to chronic back pain, as well as problems with the heart and lungs. While mild cases often don’t need treatment or can be remedied by wearing a back brace, spinal fusion and spinal implants can help to correct the more severe instances of scoliosis. The implants help to hold the spine in place and prevent it from curving.

• • Broken Vertebrae: It’s fairly common for broken vertebrae to heal on their own, without the need to for treatment. But if the vertebrae don’t heal fully or if the spine becomes unstable afterward, spinal implants can restore the stability.

• • Spondylolisthesis: When a person has spondylolisthesis, a vertebra has moved out of position, onto the bone just beneath it. In some cases, the slipped vertebra can put pressure on the nerve below, causing discomfort. Although it is possible to be born with a congenital form of the disease, the most common type is degenerative spondylolisthesis. Degenerative spondylolisthesis can develop as a person gets older and the discs between the spinal bones become smaller.
    Spinal implants can help correct the condition if it doesn’t respond to other, more conservative types of treatment. Usually, spinal fusion is performed along with a laminectomy, a surgery that removes the portion of the bone that puts pressure on the nerves.

• Herniated Disk: Sometimes called a slipped disk, a herniated disk is one that has ruptured. The fluid that used to be inside the disk can irritate the nerves around it, causing pain. Usually, surgery involves removing the burst disk, the performing spinal fusion. The implants and fusion help to stabilize the spine.

Types of Spinal Implants

You can classify spinal implants into two major categories. Spinal implants can also be sorted into several different groups, based on their shape and function.

The two major categories for spinal implants are fusion and non-fusion. As you might guess, fusion implants are used during spinal fusion surgery. They are often used along with a bone graft.

Non-fusion spinal implants include artificial disks and expandable rods. The rods are most often used during surgery to treat children with severe forms of scoliosis. Since the child is still growing, it’s important that a doctor can adjust the length of the rod as the spine grows.

Another type of non-fusion implant is a spinal cord stimulation implant. A spinal cord stimulation implant is a small device that is placed at the base of the spine, just underneath the skin. The implant works by sending an electrical signal to the brain, which interferes with any pain signals being sent.

Initially, stimulation implants helped anywhere from 50 to 60 percent of patients reduce their pain by half. Newer devices, which have a higher frequency signal, can help up to 80 percent of patients experience a significant improvement in back pain.

Fusion spinal implants can belong to one of several different groups, including:

• Cages: Also known as interbody cages, these are implants that a surgeon puts between two vertebrae. The cages usually have porous walls, so that the graft used during the spinal fusion surgery can grow into them. Often, cages help patients enjoy a more comfortable recovery period after spinal fusion. Since the cages are very good at providing support and stability, there’s usually no need for screws to hold them in place. Patients often don’t need to wear a back brace after surgery.
• Plates: Plates are a type of implant usually used to provide support to the cervical spine. They are flexible enough to bend with the spine and can be shaped and sized to fit an individual patient. Usually, plates are secured to the vertebrae with screws.
• Rods: Rods are strong and flexible. They help to stabilize and support the spine and can also shape the spine so that it is properly aligned. Typically, rods are connected to the vertebrae with either hooks or pedicle screws.

Spinal implants are usually available in a range of sizes and materials. Although many implants are made of metal, such as titanium, some are made from carbon fiber. Titanium implants are preferred because they are lightweight, solid and won’t prevent a patient from getting an MRI in the future.

Surgery to Place Spinal Implants

When spinal fusion is performed along with spinal implants, it is known as lumbar interbody fusion. A surgeon can perform lumbar interbody fusion in a variety of ways, depending on the needs of the patient. Modern surgical techniques often mean that spinal fusion can be performed in a minimally invasive way, requiring just a small incision and leaving a patient with a small, barely noticeable scar.

Types of lumbar interbody fusion are named based on the site of the incision. They include:

1. 1. Anterior Lumbar Interbody Fusion
      During anterior lumbar interbody fusion, the surgeon makes an incision on the front of the patient’s body, usually in the abdomen. In full versions of the procedure, the surgeon will move the muscles and other structures out of the way, to reach the spine. During a mini version of the surgery, the incision is smaller, and the abdominal muscles are left alone.Typically, this type of surgery is performed if a discectomy and spinal fusion are needed. A surgeon will remove any disks that need removing and will place the bone graft and implants into the spine.

1. 1. Posterior Lumbar Interbody Fusion
      A surgeon makes an incision on the patient’s back, while the patient is lying on his or her stomach, during a posterior lumbar interbody fusion procedure. This type of surgery is most commonly used to treat conditions such as spondylolisthesis and scoliosis. During the procedure, the surgeon might trim or remove facet joints and might remove the laminae, so that he or she can get to the spinal canal and disc.

1. 1. Transforaminal Lumbar Interbody Fusion
      Like the posterior lumbar interbody fusion, a transforaminal lumbar interbody fusion involves making an incision in the patient’s back, while he or she lies on his or her stomach. It’s also often recommended to patients with spondylolisthesis and to people who have recurring herniated disks.The big difference between posterior and transforaminal lumbar interbody fusion is that the latter surgery treats both the front and back of the spine. A surgeon might attach an interbody cage to the front of the spine to relieve pressure and use rods and screws on the back to create stability.

1. 1. Direct Lateral Lumbar Interbody Fusion
      During a direct lateral lumbar interbody fusion, the surgeon makes an incision in the patient’s side to get to the spine. It’s usually a minimally invasive approach, requiring only a small incision. Typically, a surgeon uses a probe or endoscope to guide him or her through the surgery.

1. Axial Fusion
   Axial fusion is another very minimally invasive surgical option for spinal fusion and the placement of spinal implants. During the procedure, the surgeon makes a tiny incision just to the side of the tailbone or coccyx.Axial fusion is different from other spinal fusion options in several ways. It’s not only very minimally invasive, but it also has a dramatically shorter recovery time. Most patients can return home the day of their surgery. Additionally, only the damaged part of the disk is removed during the surgery, and as much soft tissue as possible is left untouched, reducing the risk for complications.

Pros and Cons of Spinal Implants

Like any surgery or medical treatment, spinal implants have both benefits and drawbacks. Whether implants are the right option for you depends on how your back pain has responded to other therapies, how long you’ve been dealing with back pain and whether your doctor recommends it or not. It can be helpful to carefully weigh the pros and cons of implants and surgery before deciding.

Pros:

• Reduction in pain: Many people notice a significant improvement in their back pain after getting spinal implants and after surgery.
• You are more productive: Back pain is one of the leading causes of missed days at work. If your pain has been severe enough to cause you to call out or leave the work force altogether, surgery and implants can be what it takes to improve your productivity and get you back on the job.
• Procedure can be minimally invasive: Minimally invasive procedures are available, from spinal fusion techniques to the placing of a spinal stimulator implant. Minimally invasive techniques mean you can get back to your regular life more quickly and are less likely to have complications.
• You can wean yourself off of medication: One of the drawbacks of being in constant pain is having to take pain medications. Pain relievers can have some risks, ranging from increased risk of health problems and the risk of addiction, especially if taken on a long-term basis.
• Can be more cost effective in the long run: When you add up the wages lost when you have to take off from work, plus the cost of medicine, doctor’s visits and physical therapy, spinal implants can be less expensive in over time.

Cons:

• Risk of infection during and after surgery: All types of surgery have some risks involved, including the risk of infection. Usually, these risks are greatly minimized if a surgeon has good sterilization practices before and during the surgery. Following your surgeon’s instructions for wound care afterward will help to reduce the risk of infection.
• Surgery changes how your spine works, which can lead to new problems: Spinal fusion does just that – it fuses two vertebrae together to reduce pressure and increase the stability of the spine. Fusing the vertebrae can have some unexpected consequences, though. You might have trouble adjusting to the change in your spine, which might put new pressure on a different set of vertebrae. There is the chance that the surgery and implants will cause new pain to occur in the future.
• You may need a second surgery later on: The changes in your spine caused by the implant can mean those other areas of the spine degenerate. That can mean you’ll need another surgery years in the future.

Choosing a Surgeon for Spinal Fusion and Spinal Implants

After reviewing what spinal implants are, what they do, and the pros and cons of spinal implants, you might decide that they are a good option for you. The next step is to find a surgeon to perform the surgery and help ease your back pain.

When choosing a surgeon, there are a few things to consider. One is the surgeon’s experience with various procedures. Working with a skilled surgeon who has a background of success with spinal implants is one way to ensure that your surgery is successful.

It’s also important to look at the types of implants the surgeon uses and the types of surgeries he or she performs. Since some surgeries are considerably less invasive than others, if you are a candidate for a minimally invasive procedure, it’s a good idea to find a surgeon who performs them.

If you are ready to learn more about spinal implants or want to see if you’re a candidate for them, fill out our candidacy check form today. A spine surgeon at our practice will read over your responses and let you know which treatment is best for you.

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