Contraindications after lumbar fusion surgery

Speaking of modern medicine, it can be said to be very developed. For example, there are many surgeries for lumbar spine injuries, such as installing steel plates in the lumbar spine, lumbar reduction surgery, and lumbar fusion surgery. Today, I will focus on talking about lumbar fusion surgery? So what is lumbar fusion? What should we pay attention to after the operation? What are the contraindications of lumbar fusion? Next, I will introduce it to you in detail.

1. Indications

There are two types of lumbar spine fixation surgery: posterior and anterior. In the past, posterior surgery was mostly performed, such as transverse process fusion, facet joint fusion, "H"-shaped bone block lamina fusion, and mechanical rod fixation. However, from the perspective of anatomy and physiology, intervertebral fusion is the most appropriate. It can not only relieve the instability in the flexion and extension direction of the lumbar spine, but also relieve the lateral instability and rotational instability caused by the instability in the flexion and extension direction. If lumbar instability develops into deformity and causes compression of the cauda equina or nerve roots, stabilization surgery should be performed while relieving the compression. At this time, the choice of surgical procedure should be considered based on the patient's condition and the physician's habits.

2. Contraindications

Patients with lesions in the vertebrae to be operated on: such as vertebral infection, vertebral end plate sclerosis and tumors, etc.

Others: refers to those who are elderly and frail, unable to withstand surgery, or in poor mental state and difficult to cooperate after surgery.

3. Best time

The best time for surgery is currently under your doctor's advice.

4. Preoperative Preparation

Routine X-rays should be taken before surgery and necessary auxiliary examinations should be performed based on judgment to make a correct preoperative diagnosis and positioning.

5. Preoperative precautions

No reference material available at this time.

6. Surgical Procedures

1. Posterior fusion: Posterior spinal fusion is mainly divided into two categories: one is to fix the spinous process, namely the Albee method and double plate spinous process fixation, etc.; the other major category is to fix the intervertebral facet joints and lamina, namely the Hibbs method, improved Hibbs method, King facet joint screw fixation method, etc. Many people use a combination of the two. The double-plate spinous process fixation technique has been basically abandoned for spinal fixation, and has been replaced by Steeffe plate, Luque rod, Harrington rod, pedicle screw and other technologies.

2. Hibbs posterior spinal fusion: Make a midline longitudinal incision and cut the deep fascia and supraspinal ligament along the skin. Separate the spinous process, vertebral lamina and facet articular process from under the periosteum in turn, chisel out small bone pieces, turn them aside, and allow them to partially overlap. An appropriate amount of autologous bone is implanted on top to increase the bone graft volume and promote fusion, and then the fascia is sutured.

3. "H"-shaped bone graft fusion: Expose the vertebral lamina as before. The soft tissue between the spinous processes of the vertebrae to be fused is removed. If three vertebrae are fused, the middle spinous process is preserved. The lamina is roughened with a small chisel. According to the fusion range, first measure the length and width of the bone graft on the outer plate of the ilium, and then use a bone knife to remove the bone. Use bone rongeurs to bite open the two ends of the bone block to form an "H"-shaped bone groove. Lower the upper and lower ends of the operating table, and the upper and lower spinous processes at the fusion site will separate slightly on their own. Insert the trimmed bone graft block, press the bone graft block toward the vertebral lamina with your hands, and at the same time raise the upper and lower ends of the operating table. Small pieces of bone are placed on either side of and underneath the graft to help promote healing.

4. Intertransverse process fusion: A. Anesthesia, position and incision: General anesthesia or epidural anesthesia, prone position, make a longitudinal incision on the lateral edge of the sacrospinal muscle, with the lower end slightly bent to meet the posterior superior iliac spine. The skin and subcutaneous tissue were incised and the bleeding was stopped by electrocautery. B. Expose the transverse process: Cut the lumbar fascia at the outer edge of the sacrospinal muscle, push the sacrospinal muscle toward the midline, and you can touch the transverse process deep in the incision with your hand. The muscles and ligaments attached to the transverse process are peeled off subperiosteally along the dorsal side of the transverse process to expose the dorsal side of the transverse process, and gauze is used to apply pressure to stop the bleeding. Then peel back inward to expose the small articular process, use a bone knife to remove the cartilage surface of the articular process, and apply pressure to stop the bleeding. C. Place the bone block: Use a bone knife to perform subperiosteal stripping of the muscle attached to the posterior superior iliac spine to expose the posterior superior iliac spine. Depending on the required fusion length, a layer of iliac cortical bone is chiseled off with a bone knife, and a number of bone fragments are taken. The removed large bone block is placed longitudinally across the lumbar vertebrae and sacral vertebrae to be fused, with the upper end of the bone block placed on the transverse process and the lower end placed on the rough surface of the sacrum that has been chiseled. Aim at the middle of the bone graft and pass a screw through the bone graft and one of the middle transverse processes. Then place many small bone fragments between and near the small joints, flatten them so that they are in contact with each other without any gaps.

5. Anterior fusion: Anterior fusion is also more commonly used, including the removal of the lumbar intervertebral disc from the anterior approach, and then anterior fusion is performed after the operation. Here we introduce a technique of intervertebral body bone fusion via the anterolateral surface of the retroperitoneum