Arthrodesis and Artificial Ankylosis

Arthrodesis is a surgical procedure in which the surgeon fuses two vertebrae in the spine by placing a bone graft as a bridge, thus eliminating the facet joint that connects them. The treatment is designed to immobilize damaged joints that can occur from a number of conditions, including a vertebral fracture or severe cases of osteoarthritis, scoliosis and spondylolisthesis. Arthrodesis may be recommended when severe neck and back pain with motion due to spinal misalignment is not resolved by more conservative therapies such as physical therapy and medication.

Sometimes referred to as artificial ankylosis, the procedure is designed to eliminate or significantly reduce pain by permanently holding the joint in a fixed position through fusion with bone grafts, metal plates and rods. Results are not immediate – it takes several months for the vertebrae to completely fuse into one solid structure.

During the procedure, the patient is placed under general anesthesia and the surgeon accesses the spine from the front (anterior) or the back (posterior) to remove any fragments or bone spurs that are causing pressure on the nerve or nerve root. A bone graft from either a cadaver donor or from the patient is then inserted into the open space and secured with hardware, where it will ideally fuse to the surrounding vertebrae and stabilize the spine. It typically takes several weeks or months for the vertebrae to completely fuse together.

Once surgery is complete, the patient will remain in the hospital for monitoring and treatment of post-surgical pain with medication. Most patients remain in the hospital for two to four days. Patients are encouraged to begin walking in the hospital with assistance as soon as possible after recovering from the anesthesia. It is normal for continued pain immediately after surgery, particularly around the incision.

In some cases, a brace may be required for additional spinal support. Outpatient physical therapy may be prescribed to help with pain and inflammation, and to regain function, control and increased mobility. The surgeon will coordinate a specific postoperative recovery plan for patients based upon the type of work they perform, their preoperative activity level, the extent of their surgery and how quickly they are healing. Patients are encouraged to increase their activity level gradually. Discomfort is normal after surgery, but pain is a sign that the body needs to stop and rest.

Arthrodesis recovery is generally longer than that of other spinal surgeries, and most patients will need help with daily activities such as dressing and bathing for the first few weeks. Recovery times vary for every patient, but on average, patients recover in six to twelve weeks.

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