Sometimes a stress fracture in a vertebra causes significant, chronic pain that interferes with daily activities and is not alleviated by nonsurgical treatments. In this instance, your doctor may recommend surgery to repair the fracture and, if necessary, fuse two or more bones in the spine. These procedures can relieve pain and restore stability. Surgery may also prevent the vertebra from breaking and slipping out of place, a condition called spondylolisthesis.
At NYU Langone’s Spine Center, your surgical team may include an orthopedic surgeon or a neurosurgeon in addition to radiologists and anesthesiologists who specialize in the spine. This team of experts collaborates to confirm that surgery is the best option.
In younger children and teenagers, doctors may recommend a more conservative approach. Bracing, along with limiting contact sports for three to six months, may allow a fracture to heal. If appropriate, a limited surgical procedure can be performed to repair the fracture without the need for a fusion.
Spine surgery is always performed using general anesthesia.
Doctors may consider performing pars repair in young people, typically under age 25, who don’t have any damage to the associated spinal disc, meaning no rupture is seen, and little or no slippage, or spondylolisthesis. In this procedure, a surgeon stabilizes the fractured portion of the vertebra. He or she uses a type of metallic fixation, such as a small wire, hook, screw, or rod, to join both sides of the fractured bone and secure the vertebra in place. This stabilizes the bone and allows it to heal.
To help the two pieces of bone heal together, the surgeon may use a bone graft, a piece of bone tissue obtained from another part of the body—typically the back of the pelvic bone—to strengthen the affected bone and help it heal. Another option is a synthetic bone healing material.
Spinal fusion stabilizes the spine by permanently joining two vertebrae together, eliminating movement between them. This is the preferred procedure for spondylolysis in older people that is causing painful symptoms, or in anyone with a nearby spinal disc showing signs of degeneration.
Typically, a bone graft is placed between two vertebrae to help them fuse. In time, new bone grows to replace the graft, which acts as a scaffold. A surgeon may also place metal screws and rods into the spine to hold the vertebrae together while they heal and fuse.
Most people should expect to remain in the hospital for one or more days after surgery so doctors and nurses can monitor the spine while it begins to heal. In the days immediately following surgery, pain management specialists ensure that you have the medication you need to remain comfortable while you recover.
In addition, a physiatrist, a doctor who specializes in rehabilitation, assesses your level of mobility. Many people are able to stand or walk the day after surgery, though movement may be minimal at first. Older people may need more time to recover in bed.
Within one week of surgery, most people are able to walk and may return home. Bones tend to heal more quickly in younger people, but recovery time varies based on the type of procedure performed and the person’s health.
For four to six weeks after surgery, physical activity should be limited to gentle, low-impact movements as the spine fuses and heals. Total bed rest is not recommended, however. Walking and moving a little every day can help speed recovery and prevent complications such as a dangerous blood clot, also known as deep vein thrombosis.
After six to eight weeks, you can begin physical therapy, which helps to strengthen your core, or abdominal, muscles and improves flexibility and movement.
During the first two years after surgery, you see your doctor regularly to ensure the pars repair or fusion heals correctly. The doctor usually takes an X-ray during these appointments so he or she can confirm that the spine is stable.
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