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Tissue Engineering: Spinal Fusion. Nastasja Rittling. What is spinal fusion?. Surgical technique used to join two or more vertebrae Bone tissue is either grafted from the patient or from a donor. The Process.
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Tissue Engineering: Spinal Fusion Nastasja Rittling
What is spinal fusion? • Surgical technique used to join two or more vertebrae • Bone tissue is either grafted from the patient or from a donor
The Process • Surgeons approach it either anteriorly or posteriorly depending on the location of the problem • Incision is made, lamina is removed. If there is a bone present that causes pain, it is also removed • A bone graft is placed between the vertebrae that need to be fused • Supplemental hardware may be used to support the bone grafts until they heal: rods and screws for example • Using bone grafts from a bone bank is less painful because another incision in the patient doesn’t have to be made • 3-4 days in the hospital post-surgery
Problems being solved Most commonly treated area is the lumbar region Treats: • Degenerative disk disease • Spinal disk herniation • Discogenic pain • Spinal tumor • Vertebral fracture • Scoliosis • Kyphosis • Posterior Rami Syndrome
History • Spinal disorders and deformities were noted as far back as 3500 B.C • 1700’s- People tried to fix spinal issues with large, bulky braces
History • 1800’s- First surgical attempts to correct spinal curvatures • 1880- Lewis Sayre- made plaster casts popular in Europe • 1895- X-rays helped determine where in the spine the issue was
History • 1911- First formal spinal fusion performed by Robert Hibbs. He used a patient with tuberculosis and corrected spinal curvature using traction jackets, steel rods, and autographic bone segments • 1950’s- More advancements in spinal fusion technique • 1960’s and 1970’s- Use of Harrington rods increased • 1984- Cortrel and Dubousset created the segmental instrumentation system • 21st century- With breakthrough of tissue engineering, doctors can use bone grafts and small rods to fix spinal issues
Limitations • Possibility for additional bone surgery after the spinal fusion surgery • During the surgery, parts of the vertebra may be exposed, meaning the muscles have to be dissected in order to complete the procedure • Inflammations can occur from the surgery • Hardware may irritate the patient • Leg weakness • “Adjacent segment syndrome”-rigid segment may cause mobile segment stress
Future • Bone morphogenetic proteins will become foundation for spinal fusion • Posterior interspinous, decompressive devices • Pedicle screw based motion preservation devices • Minimally invasive fusion
Sources • Ogiela, Dennis. "Spinal Fusion." Medline Plus. A.D.A.M., Inc, 07 2012. Web. <http://www.nlm.nih.gov/medlineplus/ency/article/002968.htm>. • Lewandrowski, Kai-Uwe. Advances in SpinalFusion:Molecular Science, Biomechanics, and Clinical Management. New York: Marcel Dekker, Inc, 2004. Print. • Fairview Health Services, . Your Guide to Spinal Fusion. Minneapolis: Fairview Press, 2007. Print. • Szpalski, Marek. Instrumented Fusion of the Degenerative Lumbar Spine. Lippincott Williams and Wilkins, 1996. Print.