Spinal surgery often addresses conditions affecting the vertebrae, the small bones that make up the spinal column. One common surgical intervention is spinal fusion, a procedure designed to permanently connect two or more vertebrae. This process aims to eliminate movement between these bones, which can help reduce pain and improve spinal stability. Spinal fusion involves placing bone graft material between the vertebrae to encourage them to heal into a single, solid bone.
Defining 360 Surgery
“360 surgery,” also known as 360-degree fusion, is a comprehensive spinal fusion that involves accessing the spine from both the front (anterior) and the back (posterior) of the body. This dual approach allows for robust stabilization of the spinal segment. Its core principle is to achieve a solid bone connection between vertebrae, stabilizing the spine and alleviating discomfort from instability or deformity. It is termed “360” because it addresses the spinal column circumferentially, providing support and fusion from multiple directions. This extensive approach contrasts with single-approach fusions, which only address the spine from one side.
Indications for 360 Surgery
360 surgery is considered for spinal conditions that involve significant instability, severe deformity, or persistent pain that has not responded to other treatments. Conditions such as severe degenerative disc disease, where the discs between vertebrae lose cushioning, can lead to chronic pain and necessitate this approach. Spondylolisthesis, a condition where one vertebra slips forward over another, often requires a 360 fusion to achieve robust stability. It is also indicated for spinal stenosis with instability, a narrowing of the spinal canal that can compress nerves, or certain types of spinal fractures that cause instability. This comprehensive method provides a high degree of stability, which is often needed for these complex spinal issues.
The Combined Surgical Approach
The 360 surgical approach combines distinct anterior and posterior procedures, often performed during the same surgical session. The anterior approach involves an incision in the abdomen, providing direct access to the front of the spinal column. This access enables the surgeon to remove damaged disc material and prepare the vertebral endplates for fusion. Following the anterior phase, the patient is repositioned for the posterior approach, which involves an incision in the back. This access allows for the placement of instrumentation, such as screws and rods, and additional bone grafting material to stabilize the spine. This dual approach ensures comprehensive stabilization and a larger surface area for the bones to fuse, contributing to higher fusion rates.
Key Steps of the Procedure
During the anterior phase of 360 surgery, the initial step involves removing the damaged intervertebral disc material. The vertebral endplates, which are the surfaces of the bones surrounding the disc space, are then prepared to promote bone growth. An interbody fusion device, often a cage made of titanium or plastic and filled with bone graft material, is then inserted into the empty disc space. This device restores disc height and helps create a stable environment for fusion.
In the posterior phase, instrumentation is applied to further stabilize the spinal segment. This typically involves placing pedicle screws into the vertebrae, which are then connected by rods. Additional bone graft material is often placed along the back of the vertebrae to encourage further fusion. These steps collectively aim to prevent movement between the vertebrae, allowing them to heal into a single, solid bone over several months.
Advantages of the 360 Approach
The combined anterior and posterior access of 360 surgery offers several advantages over single-approach fusions for appropriate cases. This method provides enhanced stability to the spinal segment, which is particularly beneficial for complex conditions involving significant instability or deformity. The comprehensive stabilization from both the front and back of the spine can lead to a higher rate of successful fusion, meaning the bones are more likely to heal together solidly. This robust fusion and stability may also contribute to improved long-term outcomes for patients. The dual approach ensures that the spine is addressed from all angles, creating a strong construct that supports the healing process.