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In Situ Spinal Fusion
Spinal fusion is a procedure performed to stop growth of the spine. It can be done from the back (posterior) or through the chest (anterior) or both. The joints of the spine are removed, and a bone graft is placed; when the bone heals there will be a fusion mass, or one solid piece of bone (Figure 1)
. The goal is for the many vertebrae of the spine to become one segment and stop growing crooked. In situ fusion means that the curve will be fused "where it is" with little or no correction of the spine. Sometimes instrumentation (rods, hooks, and screws) may be placed to help straighten the spine slightly and act as an internal brace for the bone graft that will form the fusion mass. When implants are not used, usually in young children, the child may need to wear a brace or cast following the operation.
The goal of an in situ spinal fusion is to address the problem early, before it becomes a serious deformity. For example, if a pediatric spine surgeon sees a child with a 40o curve that has a poor prognosis (high chance to progress); he/she may elect to perform a limited spinal fusion to prevent the curve from getting any bigger. It is generally a safer procedure than those that correct the curvature of the spine. The results of a procedure to correct the curve at a young age can be unpredictable, as continued growth of the spine in other areas can cause the curve to progress or rotate (twist around).
Figure 1A: The exposed congenital scoliosis deformity is prepared for the fusion.
Figure 1B: The bone graft has been added to create a fusion of the deformed vertebrae. Postoperatively, the patient will be immobilized in a cast.
(John T. Killian, MD)