What is Segmental Instrumentation? Spinal Fusion

Segmental instrumentation, a crucial technique in spinal fusion procedures, involves the application of fixation devices at multiple levels of the spine to enhance stability. The Scoliosis Research Society (SRS), a leading authority in spinal disorders, advocates for segmental instrumentation in complex cases to achieve optimal correction and long-term fusion success. Pedicle screws, key components of segmental instrumentation systems, provide robust anchoring points on individual vertebrae, allowing for precise manipulation and alignment. DePuy Synthes, a major manufacturer, offers a range of segmental instrumentation products designed to meet diverse surgical needs. Understanding what is segmental instrumentation requires recognizing its role in distributing stress along the fused segments, thereby reducing the risk of adjacent segment degeneration, a common concern addressed by Dr. Arthur Steffee, a pioneer in spinal instrumentation.

Segmental instrumentation represents a pivotal advancement in spinal fusion surgery. It is a technique that has revolutionized the treatment of various spinal disorders.

Defining Segmental Instrumentation

Segmental instrumentation involves the strategic placement of fixation devices at multiple vertebral levels. These devices are interconnected to provide immediate stability.

This interconnectedness facilitates the correction of spinal deformities and promotes a solid, long-lasting fusion.

The primary purpose of this technique is to stabilize the spine. It also encourages bone growth between vertebral segments, ultimately leading to a fused, single unit.

Immediate Stability: A Cornerstone of the Technique

One of the critical advantages of segmental instrumentation is its ability to provide immediate, rigid stabilization. This is achieved through the secure anchoring of pedicle screws, rods, and connectors to the spine.

This immediate stability is particularly important in cases of spinal instability caused by trauma, tumors, or degenerative diseases. It allows patients to mobilize earlier post-operatively and reduces the risk of hardware failure.

Promoting Long-Term Fusion

Beyond immediate stabilization, segmental instrumentation plays a crucial role in fostering long-term fusion. By rigidly fixing the vertebral segments, it creates an optimal environment for bone growth and fusion to occur.

The instrumentation minimizes micromotion at the fusion site. This micromotion can disrupt the healing process.

Furthermore, the use of interbody spacers or cages, often incorporated within the segmental instrumentation construct, restores disc height and provides additional structural support. This enhances the chances of a successful fusion.

Relevance in Addressing Spinal Conditions

Segmental instrumentation is relevant in addressing a wide spectrum of spinal conditions. These conditions include:

• Scoliosis
• Kyphosis
• Spondylolisthesis
• Spinal stenosis

This technique allows surgeons to correct deformities, stabilize segments, and decompress neural elements. It is tailored to the specific needs of each patient.

Enhancing Fusion Rates and Patient Outcomes

The introduction of segmental instrumentation has significantly enhanced fusion rates and improved patient outcomes in spinal fusion surgery. Studies have shown that the use of segmental instrumentation leads to higher fusion rates, reduced rates of pseudarthrosis (non-union), and improved long-term stability.

Moreover, this technique often results in:

• Reduced pain
• Improved function
• Enhanced quality of life for patients undergoing spinal fusion

Segmental instrumentation has become an indispensable tool for spine surgeons. This is especially true when addressing complex spinal conditions and striving for optimal patient outcomes.

Indications for Segmental Instrumentation

Segmental instrumentation represents a pivotal advancement in spinal fusion surgery. It is a technique that has revolutionized the treatment of various spinal disorders.

Segmental instrumentation involves the strategic placement of fixation devices at multiple vertebral levels. These devices are interconnected to provide immediate stability and promote long-term fusion. The decision to employ segmental instrumentation is based on a variety of factors. These include the specific spinal condition, the severity of the instability, and the overall health of the patient.

Spinal Deformities: Restoring Alignment and Stability

Spinal deformities, such as scoliosis and kyphosis, represent significant challenges in orthopedic surgery. Segmental instrumentation offers a robust method for correcting these deformities. It simultaneously stabilizes the spine.

Scoliosis: Correcting Curvature

Scoliosis, characterized by an abnormal curvature of the spine, can lead to pain, reduced pulmonary function, and cosmetic concerns. Segmental instrumentation plays a crucial role in scoliosis correction.

By utilizing pedicle screws and rods, surgeons can apply corrective forces to realign the spine. This realignment not only improves the patient's posture but also alleviates pressure on internal organs and enhances respiratory function. The instrumentation provides immediate stability. It maintains the corrected alignment while the fusion process occurs.

Kyphosis: Managing Exaggerated Spinal Rounding

Kyphosis, an excessive curvature of the thoracic spine resulting in a rounded or hunched posture, can arise from various etiologies. These can include congenital abnormalities, Scheuermann's disease, or age-related degeneration.

Segmental instrumentation is instrumental in managing kyphosis. It reduces the curvature and restores a more natural spinal alignment. The technique involves strategically placing fixation devices along the affected spinal segments. This allows for gradual correction and stabilization.

Spondylolisthesis: Stabilizing Vertebral Slippage

Spondylolisthesis involves the anterior slippage of one vertebra over another. This instability can lead to back pain, nerve compression, and neurological deficits. Segmental instrumentation provides a reliable method for stabilizing the affected vertebral segments.

By securing the adjacent vertebrae with pedicle screws and rods, surgeons can prevent further slippage. They reduce pain and alleviate nerve compression. In many cases, a reduction maneuver is performed. This is to restore the normal alignment of the spine before fixation.

Degenerative Conditions: Addressing Instability and Neural Compression

Degenerative spinal conditions, such as spinal stenosis, often result in instability and nerve compression. Segmental instrumentation plays a vital role in these cases. It provides both decompression and stabilization.

Spinal Stenosis: Decompression and Stabilization

Spinal stenosis, the narrowing of the spinal canal, can lead to compression of the spinal cord and nerve roots. This compression causes pain, numbness, and weakness. Decompression, often achieved through laminectomy or laminotomy, is a primary treatment for spinal stenosis.

Segmental instrumentation is frequently employed in conjunction with decompression. This provides additional stability to the spine, particularly when extensive bone removal is required. The instrumentation prevents post-operative instability and deformity. It ensures long-term pain relief and neurological function.

Segmental instrumentation is a versatile and effective technique for addressing a wide range of spinal conditions. It restores spinal alignment, provides stability, and promotes successful fusion.

Key Components of Segmental Instrumentation

Segmental instrumentation is a complex system that relies on several key components working in concert to achieve spinal stabilization and fusion. Understanding the function and materials of these components is crucial to appreciating the biomechanical principles underlying this surgical technique. The following sections will detail each component, elucidating its role within the construct.

Pedicle Screws: Anchoring the Foundation

Pedicle screws are the cornerstone of segmental instrumentation. These specialized screws are meticulously inserted into the pedicles of the vertebrae, the bony stalks that connect the vertebral body to the posterior elements.

This strategic placement allows the screws to act as robust anchor points, effectively gripping the vertebral segment. They provide a secure foundation upon which the entire instrumentation construct is built.

The design of pedicle screws has evolved significantly over time, with variations in thread patterns, screw diameter, and screw length optimized for different spinal levels and bone densities.

In cases of osteoporotic bone, where screw purchase may be compromised, bone cement augmentation is often employed. Injecting polymethylmethacrylate (PMMA) cement around the screw enhances its fixation strength, minimizing the risk of screw loosening or pullout.

Rods: Longitudinal Stability and Alignment Correction

Rods serve as the connecting link between the pedicle screws, providing longitudinal stability to the instrumented segment. These metal rods, typically made of titanium alloy or stainless steel, are contoured to match the desired spinal alignment.

During surgery, the rods are carefully positioned to connect to the pedicle screws, applying corrective forces to address spinal deformities. The rods resist bending and torsional forces, maintaining the corrected alignment while the fusion process occurs.

The choice of rod material depends on several factors, including the patient's bone quality, the severity of the spinal deformity, and the surgeon's preference. Titanium alloys offer excellent biocompatibility and fatigue strength, while stainless steel provides superior stiffness.

Connectors and Crosslinks: Enhancing Rigidity

Connectors, often referred to as crosslinks, are devices used to interconnect the rods on either side of the spine. These components play a crucial role in enhancing the overall stability and rigidity of the construct.

By linking the rods together, crosslinks minimize the risk of rod splay or migration, distributing forces more evenly across the instrumented segment.

This increased rigidity is particularly beneficial in cases of complex spinal deformities or multilevel fusions, where greater stabilization is required.

The design of crosslinks varies, with options for both parallel and transverse connections. Surgeons carefully select the appropriate type and placement of crosslinks based on the specific biomechanical needs of each case.

Interbody Spacers and Cages: Restoring Disc Height and Promoting Fusion

Interbody spacers, also known as cages, are devices placed within the intervertebral disc space following discectomy (removal of the intervertebral disc). Their primary function is to restore disc height, decompress neural elements, and provide structural support to the anterior column of the spine.

These spacers are typically made of biocompatible materials such as polyetheretherketone (PEEK), titanium, or bone. They come in various shapes and sizes to accommodate different anatomical variations.

PEEK cages are radiolucent, allowing for clear visualization of bone graft integration on postoperative imaging. Additionally, interbody spacers provide a scaffold for bone ingrowth, promoting fusion between the vertebral bodies. The cage itself can be packed with bone graft material, further enhancing the fusion process.

Surgical Approaches and Techniques for Segmental Instrumentation

Segmental instrumentation is a complex system that relies on several key components working in concert to achieve spinal stabilization and fusion. Understanding the function and materials of these components is crucial to appreciating the biomechanical principles underlying this surgical technique. The following sections will delve into the surgical approaches and techniques used in segmental instrumentation, focusing on both traditional and modern methods.

The Traditional Posterior Approach: Direct Visualization and Wide Exposure

The posterior approach remains a cornerstone in spinal fusion surgery. It is characterized by a midline incision along the back, providing direct visualization of the vertebral elements.

This extensive exposure allows the surgeon to meticulously prepare the bone surfaces for fusion and accurately place the instrumentation.

The posterior approach facilitates comprehensive decompression of neural structures, enabling the surgeon to directly address nerve compression.

While the posterior approach offers unparalleled visualization and access, it is important to acknowledge its inherent drawbacks, including greater soft tissue disruption and potentially longer recovery times.

Minimally Invasive Spine Surgery (MISS): A Paradigm Shift

Minimally Invasive Spine Surgery (MISS) represents a significant advancement in surgical techniques for spinal fusion.

MISS techniques involve the use of smaller incisions and specialized instruments. These instruments are designed to minimize disruption of surrounding muscles and soft tissues.

Advantages of MISS: Reduced Trauma and Accelerated Recovery

The primary advantage of MISS is the reduction of tissue trauma. This leads to decreased blood loss, less post-operative pain, and a shorter hospital stay for the patient.

The smaller incisions also contribute to reduced scarring and a lower risk of infection.

Furthermore, patients undergoing MISS typically experience a faster recovery, allowing them to return to their normal activities sooner.

Technological Enablers of MISS: Navigation and Imaging

The successful implementation of MISS relies heavily on advanced technologies.

Image-guided navigation systems enable surgeons to accurately place instrumentation through small incisions. This enhances precision and minimizes the risk of malposition.

Intraoperative imaging, such as fluoroscopy, provides real-time visualization of the spine during the procedure, ensuring accurate placement of screws and rods.

Limitations and Considerations for MISS

Despite its numerous advantages, MISS is not without its limitations.

The learning curve for MISS techniques can be steep, requiring specialized training and expertise.

Complex spinal deformities or revisions may not be suitable for a purely minimally invasive approach.

The limited visualization in MISS requires surgeons to rely heavily on imaging and navigation, potentially increasing the reliance on technological support.

Therefore, careful patient selection and meticulous surgical planning are essential for successful MISS outcomes.

In conclusion, the choice between the traditional posterior approach and MISS depends on a variety of factors, including the complexity of the spinal condition, the patient's overall health, and the surgeon's expertise. Both approaches play a vital role in modern spinal fusion surgery, each offering distinct advantages and considerations.

Adjunctive Procedures Performed with Segmental Instrumentation

Segmental instrumentation is a complex system that relies on several key components working in concert to achieve spinal stabilization and fusion. Understanding the function and materials of these components is crucial to appreciating the biomechanical principles underlying this surgical intervention. However, the success of spinal fusion with instrumentation often hinges on the concurrent application of adjunctive procedures that address underlying pathologies and foster a robust biological environment for bony union. These procedures, most notably decompression and bone grafting, play critical roles in optimizing patient outcomes.

Neural Decompression: Alleviating Nerve Compression

A primary goal in many spinal surgeries is the alleviation of nerve compression, a condition that can manifest as radiculopathy (nerve pain), myelopathy (spinal cord dysfunction), or both. Decompression involves the meticulous removal of bone, disc material, or other soft tissues that impinge upon the spinal cord or nerve roots.

This is often achieved through techniques such as laminectomy (removal of a portion of the vertebral lamina), foraminotomy (enlargement of the intervertebral foramen), or discectomy (removal of a herniated disc).

The extent of decompression required depends on the specific pathology and the degree of neural compromise. Inadequate decompression can lead to persistent symptoms, while excessive decompression can destabilize the spine, highlighting the need for meticulous surgical technique and careful pre-operative planning.

Bone Grafting: Promoting Fusion

The cornerstone of successful spinal fusion is the establishment of a solid bony bridge between adjacent vertebrae. Bone grafting provides the biological impetus for this process, introducing osteogenic (bone-forming) cells, osteoinductive (bone-growth stimulating) factors, and an osteoconductive (scaffolding) matrix to the fusion site.

Several types of bone grafts are available, each with its own advantages and disadvantages:

Autograft

Autograft, harvested from the patient's own body (typically the iliac crest), remains the gold standard for bone grafting. It possesses all three essential properties for bone formation: osteogenicity, osteoinductivity, and osteoconductivity.

However, autograft harvesting is associated with donor-site morbidity, including pain, infection, and potential nerve injury.

Allograft

Allograft, sourced from a deceased donor, provides an osteoconductive scaffold and can be obtained in larger quantities than autograft.

While it lacks osteogenic potential, allograft can be supplemented with bone marrow aspirate or other growth factors to enhance its biological activity. The use of allograft carries a small risk of disease transmission.

Synthetic Bone Substitutes

Synthetic bone substitutes, such as calcium phosphate ceramics and bone morphogenetic proteins (BMPs), offer alternatives to autograft and allograft.

These materials are osteoconductive and, in some cases (like BMPs), osteoinductive. Synthetic grafts eliminate the risk of donor-site morbidity and disease transmission, but their cost and long-term efficacy compared to autograft are still under investigation.

The choice of bone graft material depends on several factors, including the patient's overall health, the size of the fusion site, and the surgeon's preference. Effective bone grafting is essential for achieving solid fusion and long-term stability after segmental instrumentation.

[Adjunctive Procedures Performed with Segmental Instrumentation Segmental instrumentation is a complex system that relies on several key components working in concert to achieve spinal stabilization and fusion. Understanding the function and materials of these components is crucial to appreciating the biomechanical principles underlying this surgical intervention. Now, we will turn our attention to the advanced technologies employed intraoperatively to enhance the precision and safety of this delicate procedure.]

Intraoperative Technologies Enhancing Spinal Fusion Accuracy and Safety

The success of segmental instrumentation in spinal fusion hinges not only on meticulous surgical technique, but also on the strategic application of advanced intraoperative technologies. These tools provide surgeons with enhanced visualization, real-time feedback, and the ability to navigate complex anatomical landscapes with greater accuracy and safety. Navigation systems, neuromonitoring, and advanced imaging modalities represent the cornerstone of modern spinal instrumentation procedures.

Navigation Systems: Guiding Precision in Screw Placement

Computer-assisted surgery, or navigation, has revolutionized the precision of pedicle screw placement. These systems utilize pre-operative imaging, such as CT scans, to create a three-dimensional model of the patient's spine. During surgery, specialized instruments are tracked in real-time relative to this model.

This allows the surgeon to visualize the precise trajectory of the pedicle screws and avoid critical structures, like the spinal cord and nerve roots.

The benefits are significant. Navigation systems have been shown to improve screw placement accuracy. This reduces the risk of malposition and the associated complications, such as nerve injury, screw loosening, or the need for revision surgery.

Furthermore, navigation can be particularly valuable in cases involving complex spinal anatomy, such as scoliosis or previous surgeries, where anatomical landmarks may be distorted or obscured. The technology provides an added layer of safety and precision, enhancing the overall reliability of the procedure.

Neuromonitoring: Safeguarding Neural Integrity

Neuromonitoring plays a crucial role in preventing neurological complications during spinal instrumentation. This technique involves the continuous monitoring of spinal cord and nerve function throughout the surgery.

By tracking electrical signals in the spinal cord and peripheral nerves, neuromonitoring can detect subtle changes that may indicate impending injury.

Several modalities are used for neuromonitoring, including somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs). SSEPs monitor the sensory pathways, while MEPs monitor the motor pathways.

Any significant change in these signals alerts the surgical team to potential neurological compromise, allowing for immediate corrective action. This proactive approach can help to prevent permanent neurological deficits, such as paralysis or weakness.

Neuromonitoring is especially crucial in complex cases, such as those involving spinal deformities or revision surgeries, where the risk of neurological injury may be elevated. It serves as a vital safety net, ensuring the integrity of the nervous system throughout the procedure.

Imaging Modalities: Visualizing Anatomy in Real Time

A variety of imaging modalities are employed during segmental instrumentation to provide real-time guidance and assess the accuracy of instrumentation placement.

Intraoperative Fluoroscopy (X-Ray):

Fluoroscopy, a type of real-time X-ray, allows the surgeon to visualize the spine during the procedure. This is particularly useful for guiding the placement of pedicle screws and other instruments. Fluoroscopy provides immediate feedback on the trajectory and depth of screw insertion, helping to ensure accurate placement and avoid penetration of the vertebral body.

Intraoperative CT Scans:

In some cases, intraoperative CT scans may be used to obtain a more detailed assessment of screw placement. This can be particularly valuable in complex cases or when navigation systems are not available. Intraoperative CT allows for precise visualization of the screw-bone interface. This confirms accurate placement and identifies any potential breaches of the vertebral cortex.

Preoperative MRI Scans:

While not used in real-time during the procedure, pre-operative MRI scans are critical for surgical planning. MRI provides detailed images of the spinal cord, nerves, and soft tissues surrounding the spine. This information is essential for identifying potential areas of compression or impingement and for planning the surgical approach. MRI can also help to identify any anatomical variations or abnormalities that may impact the surgical procedure.

Potential Complications and Important Considerations

[[Adjunctive Procedures Performed with Segmental Instrumentation Segmental instrumentation is a complex system that relies on several key components working in concert to achieve spinal stabilization and fusion. Understanding the function and materials of these components is crucial to appreciating the biomechanical principles underlying this surgic...]

While segmental instrumentation has revolutionized spinal fusion, it is not without potential complications. A thorough understanding of these risks, categorized as either hardware-related or biological, is paramount for both surgeons and patients. Careful surgical planning, meticulous technique, and vigilant post-operative monitoring are essential to mitigate these challenges and optimize patient outcomes.

Hardware-Related Complications

These complications arise directly from the instrumentation itself. They require a nuanced understanding of biomechanics and implant characteristics.

Screw Malposition

Perhaps the most concerning hardware-related issue is screw malposition. If a pedicle screw is not placed accurately within the vertebral body, it can breach the cortical bone and potentially impinge on neural structures.

This can lead to nerve root irritation, radiculopathy, or even direct spinal cord injury, resulting in pain, weakness, or sensory deficits. Furthermore, malpositioned screws can compromise the stability of the entire construct.

Revision surgery may be necessary to correct the screw placement and prevent further neurological damage or instrumentation failure. The increasing adoption of intraoperative navigation systems seeks to mitigate the risk of screw malposition.

Rod Fracture

Another potential hardware failure is rod fracture. Rods provide longitudinal stability and correct spinal alignment, and are subjected to significant stress and cyclical loading. Over time, this can lead to fatigue and eventual fracture, particularly at points of stress concentration, such as screw-rod junctions or areas of sharp curvature.

Rod fracture can result in loss of construct stability, recurrence of deformity, and pain. Revision surgery to replace the fractured rod and potentially extend the fusion may be required.

The choice of rod material, diameter, and contouring technique can influence the risk of fracture.

Biological Complications

Biological complications encompass issues related to the body's response to the instrumentation and the fusion process.

Pseudoarthrosis

A major concern following spinal fusion is pseudoarthrosis, or nonunion. This refers to the failure of the bone graft to heal and fuse the vertebral segments together. This occurs when the fusion site remains unstable, leading to persistent motion and preventing bony bridging.

Pseudoarthrosis can cause chronic pain, instability, and potentially require revision surgery to promote fusion. Risk factors for pseudoarthrosis include smoking, malnutrition, osteoporosis, and inadequate surgical technique.

Bone grafting techniques, including the use of autograft, allograft, and bone morphogenetic proteins (BMPs), play a crucial role in promoting fusion and minimizing the risk of pseudoarthrosis.

Adjacent Segment Disease

A frequently observed long-term complication is adjacent segment disease (ASD). This refers to the accelerated degeneration of the spinal segments above or below the fused level.

By altering the biomechanics of the spine, fusion can increase stress on the adjacent segments, leading to disc degeneration, facet joint arthritis, and spinal stenosis.

ASD can manifest as pain, radiculopathy, or myelopathy, potentially requiring further surgical intervention. Minimizing the number of fused segments, optimizing spinal alignment, and considering motion-preserving techniques may help to reduce the risk of ASD. Further research is ongoing to better understand the etiology and prevention of this challenging complication.

The Role of Medical Professionals in Segmental Instrumentation

Segmental instrumentation, while a powerful tool in spinal surgery, is not a panacea to be wielded lightly. Its successful application hinges on a multidisciplinary approach, with the spine surgeon occupying a central, yet not solitary, role. The complexity of the procedure and the potential for significant complications necessitate a highly skilled and coordinated team to ensure optimal patient outcomes.

The Spine Surgeon: Orchestrator of the Procedure

The spine surgeon is undeniably the key figure in the segmental instrumentation process. They are responsible for:

• Diagnosis and Patient Selection: Accurately diagnosing the underlying spinal pathology and determining if segmental instrumentation is the appropriate course of treatment. This requires a thorough understanding of spinal biomechanics, pathology, and surgical principles.

• Preoperative Planning: Developing a detailed surgical plan that accounts for the patient's unique anatomy, the specific spinal condition being addressed, and the desired corrective goals. Advanced imaging and, increasingly, computer-assisted planning tools are essential in this phase.

• Surgical Execution: Performing the intricate surgical procedure with precision and skill, including vertebral exposure, instrumentation placement, decompression (if necessary), and bone grafting. Technical expertise is paramount to minimize the risk of complications.

• Postoperative Management: Overseeing the patient's recovery, managing pain, monitoring for complications, and guiding rehabilitation.

While the spine surgeon leads the charge, the procedure is rarely performed in isolation.

The Multidisciplinary Team: A Symphony of Expertise

Segmental instrumentation benefits immensely from the involvement of a diverse team of medical professionals. Consider the following roles:

• Anesthesiologists: Crucial for managing the patient's anesthesia during the procedure, monitoring vital signs, and mitigating potential intraoperative complications. They also play a key role in postoperative pain management.

• Operating Room Nurses: Assisting the surgeon during the procedure, ensuring a sterile environment, and managing surgical instruments and equipment.

• Neuromonitoring Technicians: Operating sophisticated neuromonitoring equipment to continuously assess the function of the spinal cord and nerves during surgery, alerting the surgeon to any potential neurological compromise.

• Radiology Technicians: Providing real-time imaging during the procedure (fluoroscopy) to guide instrumentation placement and confirm its accuracy.

• Physiotherapists: Guiding the patient through a structured rehabilitation program postoperatively to restore strength, mobility, and function.

• Pain Management Specialists: Managing chronic pain, addressing any psychological or emotional issues related to pain.

• Orthotists: Providing bracing and support for the patient to limit range of motion after the procedure.

Beyond Technical Skill: The Importance of Communication and Collaboration

The success of segmental instrumentation relies not only on the technical skills of individual team members but also on their ability to communicate effectively and collaborate seamlessly. Open communication is essential for:

• Sharing critical information about the patient's condition and surgical plan.
• Promptly addressing any concerns or potential complications that arise during the procedure.
• Ensuring that all team members are working towards the same goals.

In summary, segmental instrumentation is a sophisticated procedure requiring a coordinated effort. While the spine surgeon undoubtedly holds a central role, the contributions of the anesthesiologist, nurses, neuromonitoring technicians, and other healthcare professionals are crucial for a successful outcome. Effective communication and a collaborative team approach are as important as technical skill in ensuring the best possible care for patients undergoing this complex surgery.

So, that's segmental instrumentation in a nutshell! Hopefully, you now have a better understanding of what is segmental instrumentation and how it's used to help stabilize and fuse your spine. Remember to chat with your doctor about whether this procedure is right for you and to discuss all the potential risks and benefits. Here's to a healthier back!