Fusion surgeries are indicated for advanced degeneration (spondylosis–arthritis) and resultant instabilities and pain in the spine.
People often have advanced degeneration at one level and a moderate amount of degeneration in their discs at the level above (which usually do not need fusion). These patients pose a unique challenge for treatment because you are left deciding whether to do a 1 vs. 2 level fusion.
Performing a 2 level fusion is a large procedure that one should avoid if and when possible because it can start limiting mobility. It is probably too much surgery for moderate disc disease. However, performing a single level fusion at the advanced level in these patients usually puts lots of stress on the level above and causes the disc at that level to degenerate further. At the same time, disc above is not addressed during a 1 level surgery leading to incomplete pain relief. This is the reason, you often hear about someone who had a fusion who still had pain or they needed another surgery in a year or two after the first one.
At Prairie Spine, we strive hard to minimize the number of levels we fuse while still providing sustained long term pain relief. We have been doing a hybrid procedure which is now called the Topping off procedure — this procedure combines (instrumented–transforaminal) fusion at the advanced level and interspinous stabilization at the adjacent segment using a Coflex device.
We at Prairie Spine strive hard for better outcomes after spine surgery not only short term but also long term. Topping off a Fusion with Coflex saves an extra level from being fused. It has also been documented that when the Coflex device is put adjacent to the fusion levels, it decreases the pressure in the discs and the stress on the spinal joints (facet joints). This helps to save the disc above and preserve motion while still treating all the areas of back pain. This means a more likely successful smaller surgery, less blood loss, shorter hospital stay, and quicker recovery.