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Instrumented lumbar fusion in Tijuana — Dr. Carlos A. Noreña Osterroth
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Instrumented lumbar fusion in Tijuana

Fixation of one or more spinal segments with screws and rods, to eliminate the abnormal movement causing pain. It is indicated for instability, not for pain on its own.

You fuse what moves too much

Fusion is not a treatment for back pain in general: it is a treatment for instability. The indication appears when one vertebra slips on another — spondylolisthesis — when a fracture or tumour destroys the structure, when a degenerative scoliosis progresses, or when the necessary decompression removes so much bone and facet that the segment would be left unstable.

Outside those scenarios, placing screws because an MRI shows a degenerated disc and the patient has chronic low back pain is a decision worth thinking about twice. Disc degeneration shows up on scans of people with no pain at all, and fusing a segment that is not unstable does not always take the ache away.

What goes in, and how long consolidation takes

Screws are placed in the pedicles of the vertebrae being fused and joined with rods, usually titanium. Between the vertebral bodies a spacer with bone graft is placed, and that is what will eventually produce true biological fusion: the metal holds while bone knits, and it is the bone that gives the long-term result.

Consolidation takes three to six months. During that time there are loading restrictions and a progressive rehabilitation programme. Smoking is enemy number one of fusion: it demonstrably reduces the chance that the graft consolidates, which is why stopping before surgery is pressed so hard.

What the procedure involves

Stability assessmentFlexion-extension films, MRI and, where needed, CT to measure displacement.
Pedicle instrumentationTitanium screws and rods placed under fluoroscopic control, level by level.
Interbody fusionA spacer with graft between the vertebral bodies to achieve biological, not merely mechanical, fusion.
Associated decompressionRoot release is performed in the same operation when stenosis or herniation coexists.
Post-operative programmeLoading restrictions, phased rehabilitation and radiological follow-up until consolidation is confirmed.

When it is indicated

  • Symptomatic degenerative or isthmic spondylolisthesis
  • Instability demonstrated on dynamic radiographs
  • Adult degenerative scoliosis with pain and deficit
  • Unstable traumatic vertebral fracture
  • Vertebral destruction from tumour or infection
  • Stenosis requiring extensive facet resection

Techniques and resources

  • Titanium screws and rods
  • Interbody spacers
  • Bone graft
  • Intra-operative fluoroscopy
  • Dynamic radiographs
  • Neuromonitoring where indicated

Frequently asked questions about instrumented lumbar fusion

Movement is lost at the fused segments, but the lumbar spine has five levels and the rest compensate. Fusing one or two segments rarely produces a limitation patients notice in daily life. Very long fusions do change mechanics.

No. They stay permanently and do not set off airport detectors. They are removed only exceptionally: hardware infection, symptomatic loosening, or persistent local discomfort once fusion has consolidated.

Because tobacco reduces graft blood supply and demonstrably raises the risk that fusion fails to consolidate — the most frustrating complication of this operation. Quitting before surgery is the cheapest measure that most improves the result.

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