This site complies with the HONcode standard for trustworthy health information: verify here. Patients must stay in the hospital for a period of recuperation and supervision following a spinal fusion. This may require either a revision anterior surgery or a surgery done through the back of the neck, in an attempt to get the bones to heal together or fuse solidly. The recovery period is generally six to eight weeks, with some people experiencing intense pain for several days or more following either the trial period or permanent implantation of the spinal cord stimulation devices. All statements and opinions are provided for educational and informational purposes only. They had a lumbar arthrodesis at the third lumbar level or below and their operations were performed before 1964. For procedures that require more bone, like a posterior fusion, the non-union rates are as high as 26-36% (2,3). Spinal cord stimulation risks and precautions About 30% to 40% of people experience one or more complications. Injury to blood vessels or nerves in and around the spine. "The SI joint is often glossed over as a pain generator, especially in people who have had spinal fusion and experience continued pain," says William W. Cross III, M.D., an orthopedic surgeon at Mayo Clinic in Rochester, Minnesota. This novel, comprehensive approach can help you avoid lumbar fusion and its complications. Health outcome assessment before and after anterior cervical discectomy and fusion for radiculopathy: a prospective analysis. However, spinal fusion, like any surgery comes with some risks. Blood clots, bleeding, and pain at the surgical site are potential complications of spinal fusion, according to the AAOS 13. while lowering the risks and length of recovery time associated with spinal fusion surgery. Pain at the bone graft site. Accessibility an infection in . Anterior Cervical Discectomy and Fusion (ACDF) Video, Learn how bone growth stimulation therapy can help your healing process. Taking prescribed antibiotics can reduce the risk of infections at the surgery site. A spine surgeon will use more bone, known as a bone graft, to encourage bone fusion. Your doctor uses the two vertebrae on either side of the removed disc to form a bridge (or fusion) across the bone grafts to promote long-term stability. How you prepare Accessed Nov. 22, 2022. The doctor used live imaging, such as X-rays or ultrasounds, to spot the exact location of the transplant. To learn more about this tragic complication please click on the video below. Oct. 4, 2022. At, This method includes extracting the patients healthy cells or autologous tissues, processing them, and reinjecting them into the injury site. For those who choose spinal surgery, they must realize it takes time to heal. Treatment of hardware failure often requires additional surgery to remove the broken hardware and replace it. Unlike a microdiscectomy for treatment of a lumbar disc herniation, with an ACDF there is little chance of a recurrent disc herniation because the disc is removed. The pain was so severe that you agreed to a lumbar fusion. Eur Spine J. Over time, living with chronic (long-term) pain can have serious or even severe consequences. Make a donation. The age, overall health, and physical condition of a patient influence how soon they recuperate and return to their normal activities. Schedule a Telemedicine consult and learn from a board-certified, fellowship-trained physician what options are available. 5.3k views Answered >2 years ago. The two most that you need to know are Adjacent Segment Disease and spinal muscle injury. Then the spine might need more surgery in the future. United States trends in lumbar fusion surgery for degenerative conditions. However, it can get fatigued and shatter (sort of like when one bends a paper clip repeatedly). In most cases, spinal fusion is a generally safe treatment. Learn how we can help. Tell your health care provider about medicines you take. Wang J., Dailey A., Mummaneni P., Ghogawala Z., Resnick D., Watters W., Groff M., Choudhri T., Eck J., Sharan A., Dhall S., Kaiser M. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Following a doctors orders and adhering to post operative instructions are extremely necessary to minimize the risk of complications in the weeks and months following surgery. Treatment options include PRP and your own bone marrow-derived stem cells. The highest complication was surgical site infection. Mayo Clinic; 2021. By far the most common complication following surgery is difficulty with swallowing, medically known as dysphagia. Global Spine J. Matg G, Berthold C, Gunness VR, Hana A, Hertel F. J Neurosurg Spine. Implant failure, particularly early after back surgery, is a sign of persistent severe spinal instability. We view and approach the spine as a Functional Spinal Unit. Lumbar fusion surgery has become increasingly popular. eCollection 2022 Oct 1. Unauthorized use of these marks is strictly prohibited. 2..Gill K, Blumenthal SL. eCollection 2016. This is a real problem, with an incidence of 9% (9). A rigid fusion of the spinal bones prevents further growth in . The surgery is joining two bones together, so there is a risk for decreased range of motion, indicates the AAOS, but they note that most patients will not notice a difference. The risks of spine surgery include: damage to a spinal nerve unsuccessful treatment, which can lead to pain that persists after surgery a return of back pain, particularly after spinal. VA underwent lumbar fusion several years ago for severe low back pain. The likelihood of this result becomes even more frequent with fusions of three or more levels. Chou R. Subacute and chronic low-back pain: Surgical treatment. Regrettably, as a result of these forces, the hardware can break creating spinal instability and pain. The .gov means its official. Long Term Effects of a Spinal Fusion The surgery is joining two bones together, so there is a risk for decreased range of motion, indicates the AAOS, but they note that most patients will not notice a difference. SI joint fusion surgery is considered only after those options have been exhausted. Pain at the graft site: A small minority of patients will have ongoing discomfort at the location of the bone transplant. Obtain Long Term Pain Relief. What is L5 S1 Fusion? If your initial symptoms return, tell your doctor so they can figure out whats causing them. Neurological deficits almost all resolved. 8.Greiner-Perth R, Boehm H, Allam Y, Elsaghir H, Franke J. Reoperation rate after instrumented posterior lumbar interbody fusion: a report on 1680 cases. The long-term side effects of spinal fusion surgery are mentioned below: Since the components used in this surgery involve screws, plates, and blots, there is a chance that this hardware used can fail and produce further complications such as hardware failure, spinal muscle injury and adjacent segment disease. 1991 Jul; 73(6):802-8. https://www.ncbi.nlm.nih.gov/pubmed/2071615/. Would you like email updates of new search results? style=font-weight: 400;> After removing a damaged (herniated) disc, spinal fusion may be utilized to stabilize the spine. Patients who had disc herniation, stenosis, and DDD and underwent ACDF with or without decompression were prospectively enrolled and followed for a minimum of 10 years with outcome assessment at various intervals. Unable to load your collection due to an error, Unable to load your delegates due to an error. There is also a risk that the vertebrae may not fuse together following the surgery, called pseudoarthrosis. Spinal fusion: Spinal fusion is typically performed in more severe cases, especially when multiple levels of the spine are involved. This functional unit includes discs, facet joints, ligaments, fascia, and muscles. In addition, nerve damage is a rare, but possible long term effect of having a spinal fusion 13. pain drawing, Oswestry Disability Index, and self-assessment of procedure success. Harvard Medical School makes some suggestions for alternatives for spinal fusion, as they indicate spinal fusion is only helpful in approximately 50 percent of patients 134. Hematoma or seroma causing airway compromise. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. There is also a chance of developing symptoms at of the disc levels either above or below the fused vertebrae, termed Adjacent Segment Disease (ASD). "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. You may have acute chest discomfort, shortness of breath, or coughing if this happens. Paraspinal muscle changes after single-level posterior lumbar fusion: volumetric analyses and literature review. These issues can arise from arthritis, injury, aging, or disease. The disc is an important shock absorber. AskMayoExpert. 1992;17(8):940-2. Elsevier Point of Care. It includes platelet-rich plasma (PRP) therapy and cell-based therapies. Causes Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. PRP and cell-based therapies are promising options for lumbar disc replacement and spinal fusion. Are there regenerative alternative treatments? Yes! The device entered clinical use in late 2017. See Failed Spinal Fusion Surgery. PRP is rich in growth factors that can increase blood flow and healing. Walk frequently, to the limit prescribed by your surgeon. A. Damage to the spinal cord (about 1 in 10,000) Bleeding, major blood vessel injury. Fellowship-trained from Harvard University In: Schwartz's Principles of Surgery. Thirty-seven per cent complained of persistent graft donor site pain. Make a donation. Some potential risks of cervical spine surgery include: Reactions to the anesthesia . The spinal muscles provide critical stability and support for the spine. Depending on the location and extent of your surgery, you may experience some pain and discomfort but the pain can usually be controlled well with medications. Possible complications include: Infection. 2013;7:5659. Young adult hip and pelvic conditions: Comprehensive approach for optimal care. The two that you most need to know about are Adjacent Segment Disease and Spinal Muscle Injury. Rajaee SS, Bae HW, Kanim LE, Delamarter RB. Outcomes following anterior cervical discectomy and fusion: the role of interbody disc height, angulation, and spinous process distance. Unfortunately, after the surgery, the pain never changed. Cauthen JC, Kinard RE, Vogler JB, et al. This author has been verfied for credibility and expertise. The best way to avoid these complications is to avoid spinal fusion surgery. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. An important long-term experiment compared spinal fusion to physiotherapy over more than a decade seemed to produce a contradictory result that "prevents a strong conclusion.". Lumbar spinal stenosis (adult). 2018;8(7):722-7. When spinal fusion is done from the back of the neck, known as posterior cervical fusion, rods and screws are used to hold the bones together. Rajakumar DV, Hari A, Krishna M, Konar S, Sharma A. Neurosurg Focus. However, it can get fatigued and shatter (sort of like when one bends a paper clip repeatedly). J Neurosurg Spine. Lets dig in. This lasts 3-4 days on average. "As with joints involved in cranial adjacent segment disease, the SI joint can respond adversely to the increased forces. The screws are stabilized by additional hardware including plates and rods. The good-news-bad-news conclusion was a bit of an illusion. 2008;17(8):11071112. But as with any surgery, spinal fusion carries some risks. Long-term follow-up of one hundred and twenty-two patients. The age, overall health, and physical condition of a patient influence how soon they recuperate and return to their normal activities. Patients are taught new methods to move after surgery since their flexibility may be reduced. NCI CPTC Antibody Characterization Program. This site contains no medical advice. Poor wound healing. This blog will focus exclusively on lumbar fusions. eCollection 2022. Summary of background data: In the example shown, a damaged disk is removed, a bone graft is inserted, and plates and screws hold the bones together. To assess the long-term, >10-year clinical outcomes of anterior cervical discectomy and fusion (ACDF) and to compare outcomes based on primary diagnosis of disc herniation, stenosis or advanced degenerative disc disease (DDD), number of levels treated, and preexisting adjacent level degeneration. ACDF is a proven treatment for patients with stenosis and disc herniation and results in significantly improved short- and intermediate-term outcomes. Shortness of breath or quick fatigue. Patients are taught new methods to move after surgery since their flexibility may be reduced. The most common include failed fusion where the bones do not properly fuse. Why would this occur? Non-union occurs when the spinal bones that are bolted together fail to fuse or grow together. 2017 Apr;26(4):985-997. doi: 10.1007/s00586-016-4655-5. Degenerative disc disease, herniated disc, infection, scoliosis, tumors, fractured vertebrae, spinal stenosis, and spondylolithesis are the most common cited back problems that could warrant a spinal fusion 13. Arthritis causes much of back pain. Before This novel, comprehensive approach can help you avoid lumbar fusion and its complications. Why? The disc is an important shock absorber. Adjacent-level arthroplasty following cervical fusion. There is a small plexus of nerves in front of the L5-S1 disc space that helps control ejaculation. Spinal fusion is a major surgery where one or more spinal bones (vertebrae) are fused together using screws, bolts, and or plates. When surgery is indicated, Mayo Clinic uses a new, minimally invasive SI fusion implant developed by researchers at Mayo Clinic and CoorsTek Medical and approved by the Food and Drug Administration. Its conceivable that nerves or blood vessels will be damaged as a result of these procedures. Pflugradt is a freelance writer and registered dietitian with experience in clinical nutrition and outpatient counseling for diabetes management and weight loss. Patients typically cannot resume routine activities until the bone has fused into place. The authors cherry-picked the best possible sounding news from their . If you follow all your surgeon's instructions, you can expect a smooth spinal fusion recovery that relieves your back pain and any previous numbness or tingling. Research has established that the SI joint is the source of pain in nearly half of patients who experience new or continued low back pain after fusion surgery. Every surgery comes with a risk of complications 2. All 159 consecutive patients had autogenous tricortical iliac crest bone graft and plate instrumentation used. When they replace the highly concentrated cells from your. There are several ways to do spinal fusion surgery. American Academy of Orthopaedic Surgeons. PMC J Bone Joint Surg Am 1993; 75:12981307. 2018;48(12):1430-4. 2022 Oct 11;15:3137-3156. doi: 10.2147/JPR.S375720. The long-term side effects of spinal fusion involve non-union, hardware failure, Adjacent Segment Disease, and spinal muscle injury. These are the steps in spinal fusion surgery: Some surgeons employ synthetic material instead of bone transplants in certain circumstances. Adjacent Segment Disease After Posterior Lumbar Interbody Fusion: A Case Series of 1000 Patients. Medical implants come in a variety of forms, sizes, and styles all of which are meant to treat spinal diseases in individuals of all ages. Absolutely! The doctor takes these cells from the patients adipose (fat) tissue and bone marrow. About 3.4% to 10% of people. 6.Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis. What causes spinal fusion to fail? Explore Mayo Clinic studies of tests and procedures to help prevent, detect, treat or manage conditions. Stabilization with the Dynamic Cervical Implant: a novel treatment approach following cervical discectomy and decompression. Bookshelf The surgeon uses bone grafts or metal implants to attach the . Spinal fusion is generally safe. Sometimes, surgery on the spinal bones of the neck occurs from the front. This site is for educational purposes only; no information is intended or implied to be a substitute for professional medical advice. PRP and stem cells are injected under x-ray and ultrasound guidance to promote healing and reduction in pain. Complications include failed fusion due to non-union, hardware breaking, and hardware becoming loose. During spinal fusion, a surgeon places bone or a bonelike material in the space between two spinal bones. Its time to free yourself from the pain and limitation. Among the long-term side effects of spinal fusion, there a number of problems that arise as a direct result of lumbar fusion itself. At CELLAXYS, we offer two types of regenerative treatments. 2004 Nov 15;29(22):2516-20. A blood clot can move through the circulation and end up in the lungs on rare occasions. Before your treatment, your doctor will go through all of the risks with you and take particular precautions to assist you to prevent any issues. At theCenteno-Schultz Clinic, we believe in a comprehensive approach to the treatment of spinal pain. Journal of Spine Surgery. Spinal fusion has been used to manage a variety of disorders of the lumbar spine, including tumors, spinal instability, deformity and stenosis. The surgery involves cutting through important muscles, ligaments, and tendons to access the targeted disc. doi: 10.1007/s00586-008-0695-9, 3.Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis. As with any form of surgery, laminectomy carries a risk of some side effects. What is the success rate of fusion surgery? Learn How Bone Growth Therapy Can Help You, Get a Comprehensive Evaluation from Mayo Clinic's Spine Care Experts, It is well documented in the medical literature that people who smoke have a lower rate of successful spine fusion, Anterior grafts and cages can migrate or subside, which may require repeat spine surgery. More research is needed to fully understand all of the risk factors involved so that this can better be prevented in the future. First line treatment for SI joint dysfunction consists of nonoperative management, such as physical therapy, an SI joint belt, injections and anti-inflammatory medication. Obtain Long Term Pain Relief. J Neurosurg Spine. Lumbar fusion involves screws, bolts, and plates that stabilize the spinal bones. Baron EM, et al. muscle, ligament, or nerve damage. After you go home, contact your doctor if you exhibit signs of infection, such as: It may take several months for the affected bones in your spine to heal and fuse together. 3rd ed. The L5/S1 disc is sandwiched between the L5 and S1 spinal bones. The result can be motor or sensory loss which might manifest as pain, weakness, desensitized touch, and bowel or bladder problems. This occurs when part of the hardware breaks or slips and then impinges on the spinal cord or spinal roots. Sandwiched between each of the spinal bones is a disc. There is the possibility that the surgery is not successful in treating the pain and the symptoms return. FOIA Platelets are the bodys first line of defense against injuries. This site needs JavaScript to work properly. J Am Acad Orthop Surg Glob Res Rev. https://www.uptodate.com/contents/search. Image illustrates a bilateral SI fusion procedure using the same system. Damage to the trachea/esophagus. The diagnosis of SI joint dysfunction requires an extensive patient history and comprehensive physical examination. Spinal fusion is surgery to connect two or more bones in any part of the spine. Outcomes were not related to age, gender, number of levels treated, and minimally to preexisting degeneration at the adjacent level. Spinal fusion can be used to: Spinal fusion is generally safe. Youll be laying down with a blood pressure cuff on your arm and a cardiac monitor on your chest during the treatment. The hardware may be placed in the front (anterior) or the back (posterior) of the spine. As a result, spinal hardware might be utilized as an internal splint to keep the spine in place as it heals following surgery. If the damage is permanent, the nerve will not respond to the surgical decompression and your pain will not be relieved. In those patients with normal MRIs prior to surgery, only 50 % were improved after surgery. Copyright 2023 Leaf Group Ltd., all rights reserved. The doctor will want to monitor the patients reactions to the anesthetic and operation at first. Motion preservation treatments may result in improved long-term outcomes but need to be compared to long-term ACDF outcomes reference. This can lead to additional surgeries including fusions. The most common causes of a failed lumbar fusion are nonunion, hardware breaking, and hardware becoming loose. We view and approach the spine as aFunctional Spinal Unit. Over the long term, additional surgery for pseudarthrosis (10%) occurred in the early follow-up period, and for adjacent segment degeneration (21%), which occurred linearly during the >10-year follow-up period. 4.Mohi Eldin MM, Ali AM. [emailprotected] In your procedure, your spine surgeon may utilize one type of bone graft or a mix of them. Minerva Anestesiologica. Regrettably, as a result of these forces, the hardware can break creating spinal instability and pain. While neck fusion has a good record of eliminating or reducing neck-related arm pain, tingling, and weakness, many patients want to know how much neck mobility might be lost when one or more mobile joints in the neck are fused solidand whether that can impact quality of life. Mayo Clinic is a not-for-profit organization. Part 8: lumbar fusion for disc herniation and radiculopathy. Schedule a Telemedicine consultation with a board-certified, fellowship-trained physician who can discuss your regenerative options. But as with any surgery, spinal fusion carries some risks. This offers new ways to securely walk, stand, and sit. Unfortunately, lumbar fusion significantly compromises the health and integrity of these muscles. This additional force in turn can lead to injury of these facet joints and discs leading to degeneration and arthritis. Lumbar fusion is a surgical treatment for patients with ongoing pain low back pain or leg pain that has failed conservative treatment. Spinal fusion is a major surgery where one or more spinal bones (vertebrae) are fused together using screws, bolts, and or plates. Purpose of Scoliosis Surgery. Implant failure, particularly early after back surgery, is a sign of persistent severe spinal instability. This is to keep your spine properly aligned and reduce the risks of complications 2. It involves isolating platelets from the patients blood plasma, processing them, and returning them to the site of injury. If you are experiencing serious medical symptoms, seek emergency treatment immediately. Yes, spinal fusion can cause problems later in life. Epub 2017 Mar 10. Patients must stay in the hospital for a period of recuperation and supervision following a spinal fusion. These treatments are used to restore spine stability, cure spinal deformity (such as scoliosis), and bridge space produced after a spinal decompression procedure by removing a spinal part. Spine (Phila Pa 1976). These synthetic materials aid to increase bone development and accelerating vertebral fusion. Lumbar transpedicular implant failure: a clinical and surgical challenge and its radiological assessment. Unfortunately, years later the pain continues. See Specific Questions to Ask Your Spine Surgeon, Next Page: Osteoporosis is a disease that weakens your bones, making them more susceptible to sudden and unexpected fractures. Unfortunately, after the surgery, the pain never changed. There are many reasons for this to occur. Only after your doctor can establish the source of your discomfort will they offer spinal fusion surgery. Twenty-four were not located and 8 were deceased. This offers new ways to securely walk, stand, and sit. According to the American Academy of Orthopaedic Surgeons (AAOS), the surgery is most often done to decrease pain or increase mobility caused by a number of back problems 13. The Centeno-Schultz Clinic utilizes a Functional Spinal Unit approach whereby the discs, facet, ligaments, and muscles are all evaluated and treated when appropriate. eCollection 2022. Office hours: 7am 5pm, Knee Hurts When I Bend It and Straighten It, Burning Pain on Outside of Knee When Kneeling, Muscle Pain After Cervical Fusion Surgery, Basal Joint Arthritis or CMC / Carpometacarpal Arthritis, Common Craniocervical Instability Symptoms, Perc-FSU Trusted Alternative to Spinal Fusion, Perc-ACLR - Regenexx Treatment for ACL Tear, Regenexx Non-Surgical Alternative to Cervical Fusion, Perc-CT SR Alternative to Carpal Tunnel Surgery, Non-surgical Disc Bulge or Herniated Disc Treatment, Regenexx Alternative to Ankle Fusion Surgery, Perc-CMC Alternative to CMC Joint Surgery, Spinal fusion in the United States: analysis of trends from 1998 to 2008, Functional results after anterior lumbar fusion at L5-S1 in patients with normal and abnormal MRI scans, Evaluating rehabilitation following lumbar fusion surgery, Failed back surgery syndrome: definition, epidemiology and demographics, Degenerative lumbar spondylolisthesis with spinal stenosis. Generally, the procedure involves the following: A hospital stay of two to three days is usually required following spinal fusion. Success rates vary depending upon the parameters examined. Lumbar fusion rates have increased by 336% from 1996 to 2001 (1). Delayed Esophageal Perforation Diagnosed 12 Years After Anterior Cervical Diskectomy and Fusion: A Case Report and Review of Current Literature. 1. 1998-2023 Mayo Foundation for Medical Education and Research. Two- to seventeen-year follow-up. To relieve discomfort, increase stability, or rectify a deformity, spinal fusion permanently joins two or more vertebrae in your spine. 2017 May;26(5):577-585. doi: 10.3171/2016.10.SPINE16317. Lets dig in. Mayo Clinic does not endorse companies or products. 2008;17(8):11071112. The best way to avoid these complications is to avoid spinal fusion surgery. All rights reserved. What are the indications for L5 S1 Fusion? Is there an effective, natural alternative to spinal fusion? There is a rare risk that dysphagia will be permanent. Reoperation rate after instrumented posterior lumbar interbody fusion: a report on 1680 cases, Adjacent Segment Disease After Posterior Lumbar Interbody Fusion: A Case Series of 1000 Patients. Lumbar fusion involves screws, bolts, and plates that stabilize the spinal bones. Indications for L5 S1 fusion are debilitating pain and dysfunction arising from degenerative disc disease, slipped disc, fractures, recurrent herniation, sciatica, scoliosis, and spinal canal narrowing. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). This affects patients with large and progressive curves (over 70 degrees) that compress the lungs. I am a co-founder of the Centeno-Schultz Clinic which was established in 2005. These treatments are non-invasive and less painful than conventional methods. This additional force in turn can lead to injury of these facet joints and discs leading to degeneration and arthritis. Adjacent Segment Disease and injury of spinal muscles are additional complications from fusion surgery. 2015;16:251. Following a doctors orders and adhering to post operative instructions are extremely necessary to minimize the risk of complications in the weeks and months following surgery. Board certification in Anesthesiology and Interventional Pain Medicine Surgeons perform spinal fusion while the person having the procedure is unconscious, known as general anesthesia. The hardware may be placed in the front (anterior) or the back (posterior) of the spine. The patients discharge date is determined by their general health, the physicians procedures, and the patients response to the procedure. Absolutely. Connecting them prevents movement between them. When they take cells from the adipose tissue, it is called Minimally Manipulated Adipose Tissue (MMAT) transplant. Tests say it may be cervical spinal stenosis. Blood clots. J Bone Joint Surg Am. Eur Spine J. No statements or treatments presented by CellAxys have been evaluated or approved by the Food and Drug Administration (FDA). Singleton M, et al. An official website of the United States government. VA is a recent patient seen in the clinic who experienced this complication. doi: 10.1007/s00586-008-0695-9. This is in turn can lead to spine instability and additional injuries including degeneration and arthritis. Every surgery comes with a risk of complications 2. This stresses the importance of good post-operative wound care. If there isnt enough support to hold the spine as it fuses, an instrumented fusion might fail. His low back MRI is below and is most significant for the death of the critical low back muscles. 2020; doi:10.21037/jss-20-492. The greater the patients size and the more fused segments, the greater the risk of implant failure.
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