Hybrid Techniques

It is possible to combine spinal fusion at one or more levels of the spine with other techniques, such as dynamic stabilization, at adjacent levels. Several real advantages can be gained by using a combination of techniques, each one specific and appropriate for the different problems seen at different levels.

Typical Example

A typical example would be a situation in which a patient with severe problems with back pain is found to have advanced wear and tear changes at the lowest level of the spine (L5/S1), but this is combined with moderate changes at the level above (L4/5). The changes at the lowest level are much more symptomatic and are so advanced that a fusion is required. But this will certainly transfer stress and movement to the L4/5 level with the clear risk and likelihood that this will deteriorate and cause further problems in the future. The traditional approach to this problem is to extend the fusion operation to cover both levels - a more major operation and one which necessarily stiffens two of the more mobile segments of the spine.

A more satisfactory solution in this situation is to use a combination of fusion at L5/S1 and dynamic stabilization at L4/5. A good way of achieving this is through the use of specialized rods which are rigid at one level but flexible at another (Medtronic Legacy Agile). The fusion technique is still the best option for the severe changes at the lower level but the dynamic stabilization at L4/5 resists the additional stress and movement that would otherwise be transferred to the L4/5 level. Any symptoms coming from the L4/5 level are also helped by the dynamic stabilization.

There are, of course, other possibilities. One of the real benefits coming from the range of new techniques available in spinal surgery is that we can now select appropriate solutions for the specific and varied problems in the spine, often allowing less major surgery while at the same time preserving movement in the lower back. In some instances this can mean that surgery may now be an option where, in the past and with traditional fusion techniques, it would not have been considered.

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