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Spine Surgery : Spine Fusion, Anterior Interbody Fusion
The present trend is to perform an interbody fusion. This means that the front part of the vertebras get fused together. It makes sense because this is where most of the strain on the spine occurs. Often, fusing the back part of the spine is unnecessary.
The vertebral body can be approached from the back, the side or from the front. There is also an oblique approach.
The fusion can be done with bone struts from donors or from one’s own iliac crest, with bone dowels or with cages.
Cages are metallic cylinders that look like large hollow screws, which are indeed screwed into the bone of the vertebras. They are easier to use but are only approved for at most two levels inserting them only from the back or the front. Recently, some have been approved to be inserted from the side.
Bone dowels look like cages but are made of donor bone. They have a central hole to place the bone graft material. For the surgeon, they are somewhat more difficult to use but can be placed at more than two levels.
Struts are cylinders of bone (although some types are made of metal), usually cut from large bones of donors such as the tibia or femur.
Donor bones are heavily irradiated, to kill all living tissues. Usually, there is no risk of viral transmission such as hepatitis or AIDS, but you should check with your surgeon as to what exactly is being used.
Cages, struts or dowels all have a hollow part that must be filled with one’s own bone in order for the fusion to take place. We are now using Bone Morphogenic Protein (BMP) to obtain bone fusion without having to harvest graft bone from the patient.
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