Sometimes, surgery on the spinal bones of the neck occurs from the front. In a small percentage of men who have an anterior fusion, an infrequent complication results in difficulties with ejaculation following spine fusion surgery. 4.Mohi Eldin MM, Ali AM. The same forces that can cause the hardware to break can also cause the screws to become loose. Spinal fusion is a surgical procedure in which two or more vertebrae are permanently joined. Degenerative disc disease, herniated disc, infection, scoliosis, tumors, fractured vertebrae, spinal stenosis, and spondylolithesis are the most common cited back problems that could warrant a spinal fusion 13. 2014;8(3):281-97. Mjset C, Solberg TK, Zwart JA, Smstuen MC, Kolstad F, Grotle M. Acta Neurochir (Wien). PLIF, posterior lumbar interbody fusion is a case in point that has been reviewed in detail in a prior blog. Your low back pain is crippling and has failed to respond to conservative treatments. For all diagnostic groups, significant outcomes improvement was seen at all follow-up periods for all scales relative to preoperative scores. Long-term Side Effects of Spinal Fusion | Centeno-Schultz eCollection 2022. The esophagus lies directly in front of the spine and needs to be mobilized and retracted during surgery, which can cause difficulty swallowing. If there isnt enough support to hold the spine as it fuses, an instrumented fusion might fail. Elsevier Point of Care. Would you like email updates of new search results? See if you're a Candidate for Regenexx Back Procedures. The Mayo Clinic indicates you will most likely be in the hospital for 2 to 3 days after surgery 13. These issues can arise from arthritis, injury, aging, or disease. Fusing usually takes about. 1999-2023 Veritas Health, LLC. For example, fusion may cause adjacent vertebrae to become less stable, resulting in further pain and discomfort. The age, overall health, and physical condition of a patient influence how soon they recuperate and return to their normal activities. Baron EM, et al. Emery SE, Bohlman HH, Bolesta MJ, et al. The greater the patients size and the more fused segments, the greater the risk of implant failure. Differing presentations of severe sacroiliac joint pain, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Back pain after back surgery: The SI joint and adjacent segment disease. For an ACDF surgery, the main potential risks and complications that tend to occur include: By far the most common complication following surgery is difficulty with swallowing, medically known as dysphagia. There are several ways to do spinal fusion surgery. muscle, ligament, or nerve damage. You may have acute chest discomfort, shortness of breath, or coughing if this happens. Screws are used in lumbar fusion to stabilize the spine. Therefore, L5 S1 fusion surgery involves the surgical removal of the L5/S1 disc and fusing the L5 and S1 spinal bones together. Patient satisfaction is low. Objective: The site is secure. Epub 2022 Nov 23. Spine Fusion Risks and Complications | Spine-health The best way to avoid these complications is to avoid spinal fusion surgery. 2022 Oct 17;9:983931. doi: 10.3389/fsurg.2022.983931. Thirty-seven per cent complained of persistent graft donor site pain. Epub 2022 Dec 8. The long-term side effects of spinal fusion surgery are mentioned below: Since the components used in this surgery involve screws, plates, and blots, there is a chance that this hardware used can fail and produce further complications such as hardware failure, spinal muscle injury and adjacent segment disease. This lets your surgeon and anesthesia provider keep an eye on your heartbeat and blood pressure while you are unconscious. With modern techniques happens in approximately 5% to 10% of spine fusion surgeries. Pain at the graft site: A small minority of patients will have ongoing discomfort at the location of the bone transplant. Outcomes included visual analog scale for neck and arm pain. Wang J., Dailey A., Mummaneni P., Ghogawala Z., Resnick D., Watters W., Groff M., Choudhri T., Eck J., Sharan A., Dhall S., Kaiser M. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. This is to keep your spine properly aligned and reduce the risks of complications 2. Possible Side Effects of Long-Term Spinal Cord Injury - New Mobility I've developed numbness and tingling in my fingers that gets worse after pushing up hills. 3.Greenwood J, McGregor A, Jones F, Hurley M. Evaluating rehabilitation following lumbar fusion surgery (REFS): study protocol for a randomised controlled trial. This functional unit includes discs, facet joints, ligaments, fascia, and muscles. Axial CT images illustrate two differing presentations of severe sacroiliac (SI) joint pain. The most common indications for L5 S1 fusion include: Low back disc degeneration Slipped disc ( spondylolisthesis) Spinal Bone Fracture Recurrent Disc Herniation Pain radiating down leg (Sciatica ) Curvature (Scoliosis) Narrowing of the Canal (Stenosis) Failed Spine Surgery with Instability. Spinal fusion typically works for fixing broken bones, reshaping the spine or making the spine more stable. Medical implants come in a variety of forms, sizes, and styles all of which are meant to treat spinal diseases in individuals of all ages. Blood clots. You may have acute chest discomfort, shortness of breath, or coughing if this happens. Long-term follow-up of one hundred and twenty-two patients. When spinal fusion is performed in the . 4. Get Veritas Health Newsletters delivered to your inbox. How Much Neck Mobility Is Lost After Fusion Surgery? - Spine-health 8600 Rockville Pike doi: 10.1371/journal.pone.0149312. His low back MRI is below and is most significant for the death of the critical low back muscles. Dr. Cross notes that SI joints normally move less than 1 millimeter. 2017 May;26(5):577-585. doi: 10.3171/2016.10.SPINE16317. In the best of all situations, this risk occurs in a minimum of 20% of spine fusion surgeries. Eur Spine J. Lumbar fusion involves screws, bolts, and plates that stabilize the spinal bones. Fusion surgery removes this important shock absorber placing additional stress and forces on the discs and facet joints above and below the level of the fusion. Return of symptoms. They had a lumbar arthrodesis at the third lumbar level or below and their operations were performed before 1964. Patients who had disc herniation, stenosis, and DDD and underwent ACDF with or without decompression were prospectively enrolled and followed for a minimum of 10 years with outcome assessment at various intervals. Resnick, D., Choudhri, T., Daily, A., Groff, M. Khoo, L., Matz, P., Mummaneni, P., Watters, W., Wang, J., Walters, B., Hadley, M. Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Spinal fusion can be done in the neck, thoracic, and lumbar regions. 2. Among the long-term side effects of spinal fusion, there a number of problems that arise as a direct result of lumbar fusion itself. This is done to eliminate uncomfortable motion or restore spinal stability. When they take cells from the adipose tissue, it is called Minimally Manipulated Adipose Tissue (MMAT) transplant. Arthritis causes much of back pain. Spine (Phila Pa 1976). Is cervical disc arthroplasty good for congenital cervical stenosis? Infection. All rights reserved. Mayo Clinic is a not-for-profit organization. Vertebrae are the small, interlocking bones of the spine. Before a spinal fusion, it is typically not essential to donate blood. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). SI joint fusion surgery is considered only after those options have been exhausted. 5.3k views Answered >2 years ago. Chang PY, Chang HK, Wu JC, Huang WC, Fay LY, Tu TH, Wu CL, Cheng H. J Neurosurg Spine. So far, the outcomes are promising. Two- to seventeen-year follow-up. This approach is a successful, natural alternative to back surgery without the complications outlined above. 1991 Jul; 73(6):802-8. https://www.ncbi.nlm.nih.gov/pubmed/2071615/. Lumbar fusion involves screws, bolts, and plates that stabilize the spinal bones. PLoS One. Cervical Disk Replacement Surgery | Johns Hopkins Medicine The dysphagia usually resolves within days, but there is a risk that it can last weeks to months. The spinal muscles provide critical stability and support for the spine. 2023 Jan;165(1):145-157. doi: 10.1007/s00701-022-05440-2. Long-term follow-up of lower lumbar fusion patients - PubMed Over the long term, additional surgery for pseudarthrosis (10%) occurred in the early follow-up period, and for adjacent segment degeneration (21%), which occurred linearly during the >10-year follow-up period. 2022. Every surgery comes with a risk of complications 2. Spinal Cord Stimulator: Uses, Benefits, Side Effects, Precautions At, This method includes extracting the patients healthy cells or autologous tissues, processing them, and reinjecting them into the injury site. These treatments are used to restore spine stability, cure spinal deformity (such as scoliosis), and bridge space produced after a spinal decompression procedure by removing a spinal part. Clinical Overview: Chronic low back pain in adults. Sciatica Surgery: Preparation, Recovery, Long-Term Care - Verywell Health Can the hardware break or malfunction in any way? Anterior cervical discectomy and fusion (ACDF) versus cervical disc arthroplasty (CDA) for two contiguous levels cervical disc degenerative disease: a meta-analysis of randomized controlled trials. The MRI is a cross-section image. A spinal fusion is a common surgical procedure to fuse two or more bones of the vertebrae to form a single bone 13. Measured with the visual analog of subjective pain assessment, patients' pain scores decline by roughly five points after implantation of the new device. Before your treatment, your doctor will go through all of the risks with you and take particular precautions to assist you to prevent any issues. Consider the following results: In one study 53 patients were followed for an average of 20 months after fusion surgery. Veritas Health, LLC, 520 Lake Cook Road, Suite 350, Deerfield, IL, 60015, Failed Back Surgery Syndrome (FBSS): What It Is and How to Avoid Pain after Surgery, Postoperative Care for Spinal Fusion Surgery, Scoliosis Surgery: Potential Risks and Complications, Treatment for Failed Back Surgery Syndrome Video, Diagnostic Studies, Patient History, and Physical Exams for Spinal Fusion, Additional Spinal Fusion Surgery Factors and Considerations, Back Surgery Video: How Spinal Fusion Stops Back Pain, What Causes Buttock Muscle Pain and How to Relieve it, Piriformis Syndrome: When the Symptoms Indicate a Medical Emergency, Massage to Reduce Buttock Muscle Pain from Piriformis Syndrome, Suffering from Lumbar Spinal Stenosis? Only after your doctor can establish the source of your discomfort will they offer. See Specific Questions to Ask Your Spine Surgeon, Next Page: While the bone graft sets, metal plates, rods, or screws may be used to keep the vertebrae together. Spinal instrumentation, also known as spinal implants, devices, or hardware, involves the implantation of stainless steel, titanium, titanium alloy, or non-metallic items into the spine by surgical procedures. What are the long-term side effects of spinal fusion? If you see any of these signs or symptoms, call your doctor immediately. I quit a successful career in anesthesia and traditional pain management to pursue and advance the use of PRP and bone marrow concentrate for common orthopedic conditions. Physical therapy can teach you how to move, sit, stand and walk in a manner that keeps your spine properly aligned. All statements and opinions are provided for educational and informational purposes only. Potency is not affected, and the sensation of sex is still largely the same. B. See Failed Spinal Fusion Surgery. Either way, a metal plate or rods and screws will hold the bones together until the bones heal. Experiencing back pain? This lasts 3-4 days on average. Spinal fusion can be used to: Spinal fusion is generally safe. I have been a patient with severe pain and know firsthand the limitations of traditional orthopedic surgery. 2..Gill K, Blumenthal SL. J Pain Res. 3rd ed. This procedure is called anterior diskectomy and fusion. If you follow all your surgeon's instructions, you can expect a smooth spinal fusion recovery that relieves your back pain and any previous numbness or tingling. Back pain after back surgery: The SI joint and adjacent segment disease They then can fuse and heal as one bone. Spine: Basic concepts. Oct. 4, 2022. Preventing movement helps to prevent pain. There are significant forces placed on the low back and the hardware. A. Absolutely. Is Minimally Invasive Spine Surgery Right for You? To better understand how to avoid lumbar fusions by using precisely guided PRP and stem cell injections please click on the video below. This can lead to additional surgeries including fusions. Results: As a result, spinal hardware might be utilized as an internal splint to keep the spine in place as it heals following surgery. Learn How Bone Growth Therapy Can Help You, Get a Comprehensive Evaluation from Mayo Clinic's Spine Care Experts. Patients frequently need to wear a back brace after they leave the hospital to keep their spine in good alignment. Smoking, diabetes, and advanced age can also increase the risk of developing pseudarthrosis. All 159 consecutive patients had autogenous tricortical iliac crest bone graft and plate instrumentation used. Alternatively, the same factors that caused the problems at the disc(s) that required surgery may have ultimately impacted the other discs as well. Lumbar fusion is a popular surgery. Spinal fusion connects two or more bones in the spine to make it more stable, correct a problem or reduce pain. Why? Lumbar spinal stenosis (adult). What complications can occur as a direct result of a lumbar fusion? 2015 Mar;22(3):237-45. doi: 10.3171/2014.10.SPINE131089. These structures work with one another in a highly specialized and dependent manner. The Centeno-Schultz Clinic utilizes a Functional Spinal Unit approach whereby the discs, facet, ligaments, and muscles are all evaluated and treated when appropriate. A small amount of bleeding is to be expected, although it is rarely severe. Created for people with ongoing healthcare needs but benefits everyone. Unauthorized use of these marks is strictly prohibited. BMC Musculoskelet Disord 21, 73 (2020). The complications that can occur include those that would be associated with any type of surgery, such as infection, bleeding, and anesthetic complications. All spine fusion surgeries have the potential for complications. 5. Bookshelf In about half of cases this complication resolves over the course of about 6 to 12 months. Is there an effective, natural alternative to spinal fusion? 1.Deyo RA, Gray DT, Kreuter W, Mirza S, Martin BI. A rigid fusion of the spinal bones prevents further growth in . Disadvantages and Risks of Spinal Cord Stimulation The disc is an important shock absorber. Medication may be needed to control the pain. Anterior Cervical Discectomy and Fusion (ACDF) Video, Learn how bone growth stimulation therapy can help your healing process. The most common include failed fusion where the bones do not properly fuse. Patient self-reported success ranged from 85% to 95%. Spinal instrumentation is a long-term remedy for spinal instability. Adjacent Segment Disease and injury of spinal muscles are additional complications from fusion surgery. Fusing usually takes about 3 to 6 months. Treatment options for back pain include PRP and a patients own bone marrow-derived stem cells. Salamanna F, Contartese D, Tschon M, Borsari V, Griffoni C, Gasbarrini A, Fini M. Front Surg. There is a rare risk that dysphagia will be permanent. I am a co-founder of the Centeno-Schultz Clinic which was established in 2005. The https:// ensures that you are connecting to the There are several reasons for this. American Academy of Orthopaedic Surgeons. Those changes can make pain feel more severe (hyperalgesia) or cause your nervous system to send pain signals for things that shouldn't hurt (allodynia). Spinal Cord Stimulator (SCS): What It Is & Side Effects Connecting them prevents movement between them. Poor wound healing. Adjacent-level arthroplasty following cervical fusion. Spinal fusion is surgery to connect two or more bones in any part of the spine. "It is interesting to note that this test is often normal during postoperative follow-up, making it a great marker for diagnosis and successful treatment.". Local autograft is when the surgeon takes bone from your spine. These structures work with one another in a highly specialized and dependent manner. The procedure employed by the surgeon is determined by the position of the fused vertebrae, the cause for the fusion, and, in certain cases, your overall health and body form. https://orthoinfo.aaos.org/en/treatment/spinal-fusion. Impact of Gender on Postsurgical Outcomes in Patients Undergoing Anterior Cervical Discectomy and Fusion. Outcomes were not related to age, gender, number of levels treated, and minimally to preexisting degeneration at the adjacent level. However, spinal fusion, like any surgery comes with some risks. NCI CPTC Antibody Characterization Program. From the back, it's known as posterior spinal fusion. The results of the individual surgeon with ACDF surgery (meaning that the frequency of complications varies between surgeons), and; Individual patient risk factors, such as the condition of the disc, the patients physical condition (bone strength, diabetes, etc. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Surgeons perform spinal fusion while the person having the procedure is unconscious, known as general anesthesia. This is a frequent complication of severe spine arthritis. But the waffling wasn't necessary. Global Spine J. The device entered clinical use in late 2017. Why would this occur? Patients typically cannot resume routine activities until the bone has fused into place. Spine. Mayo Clinic; 2021. Vertebrae are the small, interlocking bones of the spine. Adjacent Segment Disease After Posterior Lumbar Interbody Fusion: A Case Series of 1000 Patients. Surgeons execute spinal fusions while you are under anesthesia, so you are completely unaware of whats going on. Mayo Clinic. It involves isolating platelets from the patients blood plasma, processing them, and returning them to the site of injury. The image on the left is after the surgery. Chronic (long-term) pain: A herniated disc, causing nerve damage, is the most common cause of chronic pain after a TLIF. Lets dig in. This additional force in turn can lead to injury of these facet joints and discs leading to degeneration and arthritis. Make a donation. Regenerative medicine provides an alternative to spinal fusion. When spinal fusion is done from the back of the neck, known as posterior cervical fusion, rods and screws are used to hold the bones together. Epub 2016 Jun 17. Explore Mayo Clinic studies of tests and procedures to help prevent, detect, treat or manage conditions. These issues are more likely to arise in the first few weeks following surgery. Following a doctors orders and adhering to post operative instructions are extremely necessary to minimize the risk of complications in the weeks and months following surgery. You will not be aware of or experience any discomfort throughout the spinal fusion operation since it is performed under general anesthesia. The yellow arrows point to the muscles that were injured and now are dead as a result of the fusion surgery. Harvard Medical School makes some suggestions for alternatives for spinal fusion, as they indicate spinal fusion is only helpful in approximately 50 percent of patients 134. Secondary surgeries were performed for pseudarthrosis repair and for symptomatic adjacent-level degeneration. The disc is named for the two spinal bones it is sandwiched between. Long-term side effects and Infection after Spinal Fusion Surgery Next Page: Then the spine might need more surgery in the future. Trials. These. Cell-based and PRP therapies are performed as outpatient procedures, meaning you can go home after the treatment. Image illustrates unilateral sacroiliac (SI) fusion procedure using a system that provides a principles-based fusion, maximizing the concepts of joint preparation, compression and stability. Treatment options include PRP and your own bone marrow-derived stem cells. There are a number of complications arising from L5 S1 fusion. ACDF is a proven treatment for patients with stenosis and disc herniation and results in significantly improved short- and intermediate-term outcomes. According to the American Academy of Orthopaedic Surgeons (AAOS), the surgery is most often done to decrease pain or increase mobility caused by a number of back problems 13. CELLAXYS does not offer Stem Cell Therapy as a cure for any medical condition. The doctor used live imaging, such as X-rays or ultrasounds, to spot the exact location of the transplant. Is Minimally Invasive Spine Surgery Right for You? In: Operative Techniques: Spine Surgery. // Leaf Group Lifestyle, Complications With an L5-S1 Spinal Fusion, National Institute of Neurological Disorders and Stroke, The AAOS recommends starting physical therapy, The Open Orthopaedics Journal: Risk of Complications in Spine Surgery: A Prospective Study, Harvard Medical School - Harvard Health: Turning Your Back on Back Surgery, NIH: National Institute of Neurological Disorders and Stroke: Low Back Pain Fact Sheet, Wang J., Dailey A., Mummaneni P., Ghogawala Z., Resnick D., Watters W., Groff M., Choudhri T., Eck J., Sharan A., Dhall S., Kaiser M. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. This may require either a revision anterior surgery or a surgery done through the back of the neck, in an attempt to get the bones to heal together or fuse solidly. A small minority of patients will have ongoing discomfort at the location of the bone transplant. Youll be laying down with a blood pressure cuff on your arm and a cardiac monitor on your chest during the treatment. The disc is an important shock absorber. Anybody who has fusion surgery can develop SI dysfunction. "This is not just age-related degeneration. Rates vary depending upon the specific type of lumbar spinal fusion procedure. 1. The most common causes of a failed lumbar fusion are nonunion, hardware breaking, and hardware becoming loose. Should I avoid spinal fusion? - coalitionbrewing.com The doctor will want to monitor the patients reactions to the anesthetic and operation at first. Anterior Cervical Discectomy and Fusion Complications - Spine-health Possible complications include: Infection. "We designed this system because we think no other system fits the true philosophy of how the SI joint should be fused," Dr. Cross says. Therefore for the very best results, the spine and all its parts need to be evaluated and treated together. At the Centeno-Schultz Clinic, we believe in a comprehensive approach to the treatment of spinal pain. This is a real problem and with an incidence of 9% (6). This therapy can help with. Fellowship-trained from Harvard University The yellow arrows point to the muscles that were injured and now are dead as a result of the fusion surgery. The image on the left is after the surgery. For procedures that require more bone, like a posterior fusion, the non-union rates are as high as 26-36% (2,3). If there isnt enough support to hold the spine as it fuses, an instrumented fusion might fail. All rights reserved. Why would a lumbar fusion fail? Spinal fusion is a major surgery where one or more of the spinal bones are fused together using screws, bolts, and plates. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Its time to free yourself from the pain and limitation. Summary of background data: Lumbar fusion is a surgical treatment for patients with ongoing pain low back pain or leg pain that has failed conservative treatment. During the first two weeks of recovery, you will have several restrictions in place to facilitate healing of the spine, including: 6. Platelets are the bodys first line of defense against injuries. Office hours: 7am 5pm, Knee Hurts When I Bend It and Straighten It, Burning Pain on Outside of Knee When Kneeling, Muscle Pain After Cervical Fusion Surgery, Basal Joint Arthritis or CMC / Carpometacarpal Arthritis, Common Craniocervical Instability Symptoms, Perc-FSU Trusted Alternative to Spinal Fusion, Perc-ACLR - Regenexx Treatment for ACL Tear, Regenexx Non-Surgical Alternative to Cervical Fusion, Perc-CT SR Alternative to Carpal Tunnel Surgery, Non-surgical Disc Bulge or Herniated Disc Treatment, Regenexx Alternative to Ankle Fusion Surgery, Perc-CMC Alternative to CMC Joint Surgery, Spinal fusion in the United States: analysis of trends from 1998 to 2008, Functional results after anterior lumbar fusion at L5-S1 in patients with normal and abnormal MRI scans, Evaluating rehabilitation following lumbar fusion surgery, Failed back surgery syndrome: definition, epidemiology and demographics, Degenerative lumbar spondylolisthesis with spinal stenosis. If symptoms develop from the same disc level following surgery, it is usually because the bones did not successfully heal togetherwhich is called a nonunion or pseudarthrosis. Obtain Long Term Pain Relief. To learn more about this tragic complication please click on the video below. What Are the Long-Term Effects of a Spinal Fusion? | Healthfully It is important to note, however, that the absence of degenerative changes in the SI joint does not eliminate the SI joint as a potential pain generator.". To stabilize the spine, screws are placed into the spinal bones above and then below the disc that is removed. Image shows no significant joint degeneration. style=font-weight: 400;> After removing a damaged (herniated) disc, spinal fusion may be utilized to stabilize the spine. To assess the long-term, >10-year clinical outcomes of anterior cervical discectomy and fusion (ACDF) and to compare outcomes based on primary diagnosis of disc herniation, stenosis or advanced degenerative disc disease (DDD), number of levels treated, and preexisting adjacent level degeneration. On the right, the yellow arrows point to dark healthy spine muscles that were present prior to the surgery. The likelihood of this result becomes even more frequent with fusions of three or more levels. Spinal fusion in the United States: analysis of trends from 1998 to 2008. This content does not have an English version. Spine. Clipboard, Search History, and several other advanced features are temporarily unavailable. AskMayoExpert. Some people may have a repeat of their initial symptoms. Perioperative management in complex spine surgery. Klein GR, Vaccaro AR, Albert TJ. Injury to blood vessels or nerves in and around the spine. Nerve root damage. "But with force transfer after spinal fusion, the SI joints can move a couple of millimeters," he says. "For some patients, that's exquisitely painful. This offers new ways to securely walk, stand, and sit. When they replace the highly concentrated cells from your. The disc between the spinal bones is often times removed and replaced with bone or a spacer. 6.Okuda S, Yamashita T, Matsumoto T, et al. Laminectomy: Types, recovery, and complications - Medical News Today Eur Spine J. 2017 Feb;42(2):E5. Patients are taught new methods to move after surgery since their flexibility may be reduced. His low back MRI is below and is most significant for the death of the critical low back muscles. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. This novel, comprehensive approach can help you avoid lumbar fusion and its complications. It is most usually extracted from your pelvis, leg, or ribs. Spine (Phila Pa 1976) 2000; 25:801803. Surgeries are often extremely painful and have a very long recovery time.