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What is the procedure for a spinal fusion?

Q) I've had rheumatoid arthritis for 15 years which is quite well controlled with methotrexate and a non-steroidal anti-inflammatory drug (NSAID). Three years ago I started to suffer with sciatica and have tried all the treatments available. I now walk with a stick. My MRI scan has shown that my discs have collapsed in my lower back, pressing on the sciatic nerve. The orthopaedic surgeon has suggested spinal fusion and I was wondering if you could explain this procedure for me.
Sylvia, St Austell (Winter 2008

A) It sounds like you have very severe degeneration in the bones and joints at the base of your spine. Some research we did about 20 years ago found that back pain is very common in people who have rheumatoid arthritis and that there are various causes of this. Firstly, the bone density is often reduced in rheumatoid arthritis and this can lead to fracture of the bones (called collapsed vertebrae). Secondly, the inflammation and pain of rheumatoid arthritis can occur in the spinal joints. Thirdly, the tissues of the spine can degenerate with time leading to spondylosis. In this case, the bones, discs and ligaments become disrupted and this can cause irritation of the spinal nerves, leading to sciatica. In your case I'd think that a simple operation to remove the small amount of tissue pressing on the nerve is unlikely to be enough to prevent it recurring. A spinal fusion operation does what is says: over a short segment the spinal bones are permanently joined (using metal bars and bone chips). The purpose of this is to remove the nerve irritation and prevent further degeneration of the spinal tissues. It's a major operation and should only be undertaken when other options have failed. The other options include strong painkillers, TENS machines and spinal injections, which you may have already received.

This answer was provided by Dr Philip Helliwell for the Winter 2008 edition of our magazine, Arthritis Today, and was correct at the time of publication.

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