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Your Trusted Alternative to Spinal Fusion

The perc-fsu | Percutaneous-Functional Spinal Unit

If information about spinal fusion surgery has you concerned or reticent, you should know that there are alternatives to having major spinal fusion surgery. There is another way. Centeno-Schultz has been using this alternative to spinal fusion for the last decade with great success (1). This groundbreaking procedure is a fusion substitute pioneered by our team, called the Perc-FSU Procedure.

The Perc-FSU Procedure is an injection-based treatment that utilizes the patients’ own blood platelets to bring stability to the spine without the need for the rods, nuts, bolts, and hardware of fusion surgery. “Perc” stands for percutaneous, and “FSU” stands for “Functional Spinal Unit,” which means that the spine is treated as one functioning unit. Up and down the spine, the discs, facet joints, ligaments, and muscles that assist in stabilizing the spine are treated with image guided injections to help bring stability to the spine as a whole. It is the trusted alternative to spinal fusion.

Meet the Perc-FSU

What Are the Complications Associated with Spinal Fusion?

An unfortunate and major complication of spinal fusion surgery is an overall failure of the procedure. Spinal fusion can fail, and there are a few main ways that happens, to include:


 Non-union: If the segment being fused with the bone fails to grow together, this is called “non-union.” The rate at which non-union occurs is highly dependent upon the type of spinal fusion surgery performed. If a procedure requires more bone, such as a posterior-lateral fusion, non-union rates can be as high as 26 – 36% (2,3)

➜ Hardware that loosens or breaks, or pain resulting from hardware used: These hardware-centric complications are a common reason that second surgeries need to be performed after the initial fusion. Overall, roughly 13% of patients undergoing fusion because of low-back problems require a second surgery (4).

RIP Back Fusion Surgery


➜ Adjacent segment disease (ASD): ASD is caused by excessive force on vertebral levels above or below the fusion area, causing them to be worn out because of the immobile fusion (5). It is estimated that as many as 12% of patients will develop ASD within two years of their spinal fusion procedure (16), and 2 – 4% of patients will develop this problem for every year post-fusion, for example, at 5 years from the fusion date, 20% of patients will have developed ASD (6).

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Will the Perc-FSU help if I’ve Already Had Back Fusion?

  • Fusion predictably breaks down the unfused vertebral segments below and above fusion site
  • The solution is NOT more fusion
  • The Perc-FSU can help by strengthening the ligaments, muscles, joint, and nerves below and above the site of the back fusion

Before and After MRI of Perc-FSU Procedure

Patient 1

Before:

Before MRI - Perc-FSU - The Trusted Alternative to Spinal Fusion

After:

After MRI - Perc-FSU - The Trusted Alternative to Spinal Fusion

Frequently Asked Questions

What is spinal fusion, anyway? Why would someone need their spine fused?

When patients go in for continual low back pain, they could be found to have chronic pain problems or degenerative disc disease — problems that won’t go away on their own. Instead of leaving them untreated and surely allowing the pain to get worse, spinal fusion surgery is often recommended. This surgery is done by fusing certain segments of the spine together, typically with bone and/or hardware, in order to prevent motion from that particular spinal segment. The idea is that, with little to no motion, further erosion and increased pain cannot occur.

How well does spinal fusion work? What is the success rate?

This answer is a bit more complicated because the research has shown that the success rate for spinal fusion is largely dependent on the reason someone needs surgery in the first place. In the largest published investigation to date, researchers looked at the results of 65 studies and more than 300,000 patients and found that the success rates were variable; there wasn’t, in this study, a definitive answer on the success rate of spinal fusion for surgical patients with low back pain, versus patients with low back pain who opted out of surgery (7). Furthermore, there was no difference in pain levels between those who underwent spinal fusion and those who did not. For patients who had a slipped vertebra (otherwise known as spondyloisthesis), the spinal fusion procedure did have greater success; however, most patients who pursue spinal surgery are not in that category, but instead have chronic low back pain. The research shows that, for these patients that make up the majority, the fusion surgery did not make any distinguishable improvements upon their way of life.

Is spinal fusion considered a major surgery?

In a word, yes. Because complications resulting from spinal fusion are common, this procedure is considered major surgery. Research demonstrates that surgeons can underestimate complications (9), and that the serious complication rate of spinal surgery is 10-24%, according to an analysis that reviewed five larger studies on the same subject (10). Even when minimally invasive fusions were used, which are comprised of smaller incisions, the reported complication rate was 19%, with some studies reporting fusion complication rates as high as 31% (11). Side effects from spinal fusion can also include nerve damage and infection, among other problems that can lead to a need for more surgery.

How long will I be in recovery after spinal fusion?

Depending upon the type of surgical method used, patients can expect to be prescribed narcotics for lingering pain for between two and nine weeks post-surgery (5-7). Recommended time away from work can vary from as little as seven weeks to more than six months, depending upon the patient, the surgical method, and any potential complications. Most surgeons tell their patients that they can expect to wait a year before full recovery has taken place.

What is failed back surgery syndrome?

There is no ambiguity in this phrase. This is the diagnosis you could receive if your back surgery failed to reduce pain and increase function. Unfortunately, this happens often, estimates ranging from 20 – 40% of patients that undergo low back surgery will develop failed back surgery syndrome (17).

Is the Perc-FSU an alternative for spondylolisthesis surgery?

Spondylolisthesis is a Latin term that basically translates to “slipped spine” – “spondy” translating to spine and “listhesis” to “slipped.”

There are two main categories of this condition:
1. Trauma induced – This is when the bone that separates the facet joints, the pars interarticularis, is broken, allowing the vertebral bodies to “slip” and move around. As you may have guessed, this can cause irritation (esp. to the nerves) and pain.
2. Degenerative spondylolisthesis – This means it is degenerative and a condition that a person can have from birth. When the facet joints of the spine get arthritic, they become deformed.

Treating spondylolisthesis involves treating the spine as a functional unit, thus stabilization of the spine here is like treating other spine conditions. Meaning, because we use platelet based procedures to tighten up and strengthen ligaments,  epidural, facets, multifidus muscles, painful tendons, and sometimes discs.

References

(1) Centeno C, Markle J, Dodson E, et al. The use of lumbar epidural injections for treatment of radicular pain. J Exp Orthop. 2017;4(1):38. Published 2017 Nov 25. doi: 10.1186/s40634-017-0113-5

(2) Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg Am. 1991 Jul; 73(6):802-8. 

(3) Tsutsumimoto T, Shimogata M, Yoshimura Y, Misawa H. Union versus nonunion after posterolateral lumbar fusion: a comparison of long-term surgical outcomes in patients with degenerative lumbar spondylolisthesis. Eur Spine J. 2008;17(8):1107–1112. doi: 10.1007/s00586-008-0695-9

(4) Greiner-Perth R, Boehm H, Allam Y, Elsaghir H, Franke J. Reoperation rate after instrumented posterior lumbar interbody fusion: a report on 1680 cases. Spine (Phila Pa 1976). 2004 Nov 15;29(22):2516-20. https://www.ncbi.nlm.nih.gov/pubmed/15543064

(5) Saavedra-Pozo FM, Deusdara RA, Benzel EC. Adjacent segment disease perspective and review of the literature. Ochsner J. 2014;14(1):78–83. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3963057/

(6) Tobert DG, Antoci V, Patel SP, Saadat E, Bono CM. Adjacent Segment Disease in the Cervical and Lumbar Spine. Clin Spine Surg. 2017 Apr;30(3):94-101. 

(7) Yavin D1, Casha S1, Wiebe S, Feasby TE, Clark C, Isaacs A, Holroyd-Leduc J, Hurlbert RJ, Quan H, Nataraj A, Sutherland GR, Jette N. Lumbar Fusion for Degenerative Disease: A Systematic Review and Meta-Analysis. Neurosurgery. 2017 May 1;80(5):701-715. doi: 10.1093/neuros/nyw162.

(8) Wang X, Borgman B, Vertuani S, Nilsson J. A systematic literature review of time to return to work and narcotic use after lumbar spinal fusion using minimal invasive and open surgery techniques. BMC Health Serv Res. 2017;17(1):446. Published 2017 Jun 27. doi: 10.1186/s12913-017-2398-6

(9) Ratliff JK, Lebude B, Albert T, Anene-Maidoh T, Anderson G, Dagostino P, Maltenfort M, Hilibrand A, Sharan A, Vaccaro AR. Complications in spinal surgery: comparative survey of spine surgeons and patients who underwent spinal surgery. J Neurosurg Spine. 2009 Jun;10(6):578-84. doi: 10.3171/2009.2.SPINE0935.

(10) Zaina F, Tomkins-Lane C, Carragee E, Negrini S. Surgical versus non-surgical treatment for lumbar spinal stenosis. Cochrane Database Syst Rev. 2016;2016(1):CD010264. Published 2016 Jan 29. doi:10.1002/14651858.CD010264.pub2

(11) Joseph JR, Smith BW, La Marca F, Park P. Comparison of complication rates of minimally invasive transforaminal lumbar interbody fusion and lateral lumbar interbody fusion: a systematic review of the literature. Neurosurg Focus. 2015 Oct;39(4):E4. doi: 10.3171/2015.7.FOCUS15278.

(12) Adogwa O, Parker SL, Bydon A, Cheng J, McGirt MJ. Comparative effectiveness of minimally invasive versus open transforaminal lumbar interbody fusion: 2-year assessment of narcotic use, return to work, disability, and quality of life. J Spinal Disord Tech. 2011;24(8):479–484.  https://www.ncbi.nlm.nih.gov/pubmed/21336176

(13) Parker SL, Adogwa O, Bydon A, Cheng J, McGirt MJ. Cost-effectiveness of minimally invasive versus open transforaminal lumbar interbody fusion for degenerative spondylolisthesis associated low-back and leg pain over two years. World Neurosurg. 2012 Jul;78(1-2):178-84. doi: 10.1016/j.wneu.2011.09.013.

(14) Parker SL, Mendenhall SK, Shau DN, Zuckerman SL, Godil SS, Cheng JS, et al. Minimally invasive versus open Transforaminal lumbar Interbody fusion for degenerative Spondylolisthesis: Comparative effectiveness and cost-utility analysis. World Neurosurg. 2013.

(15) MacDowall A, Canto Moreira N, Marques C, Skeppholm M, Lindhagen L, Robinson Y, Löfgren H, Michaëlsson K, Olerud C. Artificial disc replacement versus fusion in patients with cervical degenerative disc disease and radiculopathy: a randomized controlled trial with 5-year outcomes. J Neurosurg Spine. 2019 Jan 11;30(3):323-331. doi: 10.3171/2018.9.SPINE18659.

(16) Tobert DG, Antoci V, Patel SP, Saadat E, Bono CM. Adjacent Segment Disease in the Cervical and Lumbar Spine. Clin Spine Surg. 2017 Apr;30(3):94-101. doi: 10.1097/BSD.0000000000000442. [Google Scholar]

(17) Thomson S. Failed back surgery syndrome – definition, epidemiology and demographics. Br J Pain. 2013;7(1):56-59. doi:10.1177/2049463713479096.