Definition and Overview
Also known as spinal fusion surgery, arthrodesis is a surgical procedure that adds a bone graft to fuse two ends of a joint to reduce or eliminate bone and joint pain.
Although arthrodesis can occur naturally, it can also be achieved by going through a surgical procedure. The needed bone can be taken from the patient’s body (autograft) or from a substitute such as that of a cadaver. It can also be obtained from a tissue bank and may be synthetic.
The surgery is normally done on the spine, but it can also be performed in the thumb, finger, wrist, spine, and knees. Arthrodesis can also be classified based on the number of joints to be fused. As such, an operation to the feet can be double or triple arthrodesis.
Who Should Undergo and Expected Results
Arthrodesis is conducted when the joints, or articulations that connect the bones, are damaged that they begin to cause chronic and severe pain to the patient, limiting their mobility, increasing their morbidity, and reducing their quality of life.
There are many possible causes of joint degeneration with arthritis being one of the leading reasons. It is described as the inflammation, swelling, and redness of the joints. In severe cases, it can lead to the deformity of the hands, thumbs, and knees. The damage may occur due to old age, trauma, congenital defects, and other underlying conditions.
If the problem affects the spine, the pain may be brought about by a herniated disc. This occurs when one or more of the discs of the spine bulge out, irritating the nerves that serve as a communication pathway to the brain. As a result, pain signals are transmitted more frequently and in higher intensity. Other possible reasons are scoliosis and spine injuries, including spine fracture.
Usually, these conditions can be treated using non-surgical methods such as through medications, rehabilitation, and pain injections. However, for excruciating pain that does not respond to all non-surgical treatments, arthrodesis is considered.
Because arthrodesis removes the affected joint, the area of the body operated can become stiff or inflexible. The procedure also doesn’t treat the actual cause of the degeneration. However, the bone graft can reduce or get rid of the pain as well as offer stability allowing the affected bone to effectively carry the weight of the body.
How Does the Procedure Work?
Before the procedure, pre-surgical tests are conducted and necessary preparations are discussed to the patient to ensure the success of surgery and ensure patient safety. These include:
- Physical and blood tests
- Imaging exams
- Patients who smoke will be advised to stop as soon as possible
- Patients who are taking certain medications, such as blood thinners, will be advised to stop taking them about a week before the procedure
- 12-hour fasting prior to surgery
The surgery starts with an anaesthesiologist administering general anaesthesia, which means that the patient will be asleep throughout the procedure. Once anaesthetics have taken effect, an incision is made on the affected part of the body to access the problematic joint.
Using surgical tools, the surgeon will access and remove the problematic joint before planting the bone graft material. Screws, rods, and plates are then used to secure the connected bones, and the incisions are closed. The patient may have to wear a back brace until he is completely healed.
The operation can take at least an hour depending on the severity of the condition and the number of problematic joints. The patient may be allowed to leave the hospital after three days but is expected to undergo rehabilitation for months.
Possible Risks and Complications
Patients who have undergone spinal fusion surgery mostly complain about pain days after the procedure. This can be resolved by taking pain relievers prescribed by their doctor. Infection is also another potential complication, as well as bleeding. In rare cases, the nerves can be damaged or the screws and plates detached from the bone graft.
- Wood GW III. Arthrodesis of the spine. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics. Philadelphia, PA: Elsevier Mosby; 2012:chap 39.