In a degenerative spondylolisthesis, one vertebrae slips forward on another and in the process may pinch a nerve root. This can result in sciatica on a repetitive process and may be extremely problematic and painful for patients on a daily basis. The term for this is spinal stenosis. Pain may radiate down to the legs and feet and cause difficulty with ambulation, work ability, recreational activities, and hinder social efforts.
A spinal fusion may dramatically help with the symptoms if conservative measures fail. Conservative measures include pain management options that may be interventional pain management (epidural injections), pain medications, physical therapy, chiropractic, or spinal decompression therapy.
In a spinal fusion, the surgeon initially removes the lamina, the bony portion of the spine that covers the spinal cord and its remnant. This is called a laminectomy and effectively decompresses the areas experiencing pinched nerves. The pre-operative MRI tells the surgeon which areas are being pinched and where to focus his or her efforts. There may be some additional findings during surgery, but taking a "we'll see what's going on when I get in there" approach is not the best.
The bone removed is saved and ground up and typically an additional biologic substance is supplemented to this material. On the outside of the spine on each side, this bony material, called bone graft, is placed and the remaining bony areas on the spine are "roughed up" to encourage bony healing and hence a bony fusion. The spinal fusion will weld one level to another so that movement will no longer occur.
In many cases, screws and rods are placed in the vertebrae to stop movement between the affected levels. This hardware keeps the levels firmly in place while the bony fusion takes place. So basically you have the spinal decompression portion to free up pinched nerves and then the spinal stabilization part to prevent further slipping or instability.
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