Life after spinal fusion: learning to walk, rehabilitation, recovery
Arthrodesis — functional immobilization of joints
Arthrodesis is a special type of surgery.
The surgery is performed on joints at which they are fully obezdwijivanie and artificially fixed in a particular position.
This operating method of fixing is required for the restoration of supporting ability of a «loose» subjected to deformation, loss of mobility and efficiency of the limb.
When assistance is inevitable
The need of this treatment most often occurs when:
- loose joints – complete or partial deformation of the interosseous connections, which causes a deficiency or complete atrophy of articular mobility (prolonged muscle paralysis, torn ligaments, a gunshot wound, excessive extension of the joints, etc.);
- complex (deforming) arthritis – this applies mainly to the pathology of osteo-articular tuberculosis; purulent or traumatic arthritis;
- complicated by degenerative arthritis, the lesions of the joint, resulting in abnormal changes in the epiphyses of bones;
- a consequence of polio;
- improperly fused or fused fracture;
- in case of impossibility of use of plastic surgery on damaged joints with the use of a partial or full denture or insertion of specialized records.
As well as a number of other reasons that minimize active movement in the joint, and maximizes passive.
A clear prohibition
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Arthrodesis is contraindicated.
So, it is not carried out:
- in the period of intensive growth of the skeleton and development of bone muscle mass – children up to 10-12 years;
- when expressed non-tuberculous fistula – diseases of the tissues caused by infection, microorganisms which defy classification, but according to clinical manifestations similar to the tubercular (in other words, atypical mycobacteria);
- local lesions of joints and tissues with a marked tendency to suppuration;
- heavy and unstable condition of the patient;
- the age at which the rehabilitation period and postoperative risks are increased significantly, mostly after age 60.
There are four main types of this surgery:
- intra — articular cancellation (not to be confused with sprout!) cartilage;
- extra-articular attachment of the bone through the use of material taken from the body of the operated (avoids process rejection) or donor bone autograft;
- combined (combo) – parallel removal of the articular cartilage and strengthen the bones or through a transplant or by the implantation of highly durable metal locking plates;
- extension – a dissection (artificial fracture) and consistent, strictly metered traction bone with help of Ilizarov apparatus.
There is also a method of compression of the articular surfaces using special devices (needles, rods, hinges, etc.) — compressive arthrodesis.
As a rule, different injury and pathological changes in affected hip, knee, shoulder, ankle and metatarsophalangeal joints. Them and conducted various types of surgical operations.
Elimination of pain in the hip joint
The need for arthrodesis of the hip joint occurs when the restriction and painful restricted movement in the hip joint as a consequence of:
- spastic paralysis and apparent;
- lesions of the cartilage of the articular surfaces that cooperate under the definition of «deforming osteoarthritis»;
- degenerative and extremely painful osteoarthritis of the hip joint causing the bone tissue;
- dislocation and traumatic defeat.
And only in the case where it is not possible to have a plastic surgery or joint replacement implants.
With this type of surgical intervention can be applied to all five types of surgery. Thus the patient first removes a potential source of infection: all of dead and mutated tissue.
Is nadechka cartilage layer of the head and Vetlugina cavity of the pelvis, including the intermediate (spongy) layer. If a head is broken, it is partially or completely removed.
Released bones grind and connect using stiff coupling. To eliminate the risk of displacement of the bones after surgery on the operated body volume is superimposed plaster bandage from the chest to the end undergoing surgeries of the limbs.
For more reliable fixing of the gypsum is also superimposed on the healthy leg from the hip to the knee.
Learning to live and walk after arthrodesis
The period of splicing and rehabilitation lasts quite a long time. The patient will be able to rise to his feet (with the help of specialized orthopedic appliances, grasping it from his chest!) only after 6-7 months.
But before he is in a cast for at least three months. After this period, the bandage is removed, the necessary radiographs, and if there is a positive trend, the patient is again superimposed plaster bandage at least three or four months.
Its area is less than in the first case, while the healthy leg remains free.
It is important to note that this surgery – not hip replacement. This is the last remedy of the disease, accompanied by unbearable pain.
After the joint is immobile, but the pain that tormented man until the pores are eliminated.
Radical elimination of diseases of the knee
The indications for arthrodesis of the knee joint can become extremely critical situation arising:
- excruciating pain, occurring due to degenerative arthritis causing foot deformities and loose joint;
- prolonged muscular paralysis, and progressive pathological reflexes caused by polio and paraparesis.
Mainly on the knee joint is intraarticular arthrodesis.
In this case the damaged joint of the patient is opened by its front appearance, after which it is bent, remove articular cartilage and tibial cartilage of the condyles of the femur.
Sometimes between the ends of the bones are placed patella is to improve the fixation. All fabrics are sewn with a layer by layer, the wound dried. The knee bend necessary to splice the joint angle and a plaster bandage.
As a rule, the strengthening of joint occurs within three months, however, the final removal of the plaster takes place only after 4-5 months.
Extra-articular method of surgery is usually very rare. It is used a graft from a donor or your own tibia of the patient that is fixed in an artificially created trough in the front appearance of the patella and the femur.
It is important that the knee joint after this type of operation always remains stationary.
Immobilization of the shoulder
This type of operation is used when it is not possible to revive the function of the shoulder joint. The movement may be atrophied due to:
- old and time untreated injury of the humeral head;
- running sprains;
- tuberculosis of the shoulder joint.
It is possible to use intra-articular, extra-articular compression and the type of operation.
In the first case, the fragments are removed from the upper and middle poles of a dislocated bone, is cancelled articular cartilage, the humeral head is fixed to the corresponding articular cavity, tissue wounds, sewn with a is applied on top of the plaster bandage.
Period of wearing it at least three months.
The second – applied upper and lower arthrodesis. The top is used for the autograft of the humerus. For the bottom – from the outer edge of the shoulder blade muscles which are not removed.
Circular plaster bandage in this case is superimposed on allotted a certain angle the shoulder with the outside hand for three to four months.
When the compression technique uses the Ilizarov apparatus.
Immobilization of the ankle
Indications for arthrodesis of the ankle joint are:
- dangling foot, as a consequence of polio;
- diffuse changes in tuberculosis of the ankle;
- progressive arthritic deformation;
- napravlennye or bad fused dwuhlopastny fractures.
For commit and recovery support ability of the limb are used by almost all types of surgery.
Depending on the region of the limb on which surgery is performed (heel, foot, the area of the medial ankle…).
In the most common method of operation of the exposed ankle scraped articular cartilage and articular layer at the tibia and talus bones.
Then the bones between them are fixed with the help of grafts and with the use of specialized steel plates, screws, screws, long studs.
How to recover?
Plaster bandage is removed after the expiration of 3-5 months, depending on the complexity of the operation.
It is important to know that life after arthrodesis of the ankle will never be the same, the joint becomes painless and immobility forever. However, the movement can be partly compensated by the nearby joints of the foot.
Procedure at the metatarsophalangeal joint
The main reason for this operation is arthritic pain front – the finger of the foot.
The main object of the arthrodesis of the big toe. By the way, this is the most fleeting type of surgery, the duration of which does not exceed 50 min.
During the operation uses its intra-articular form: opened from the side of the soles the metatarsophalangeal joint articular cartilage is removed, the processed ends of the metatarsal head and dense bone.
Then the cleaned bone fragments are fixed tightly, clinging to each other at a certain angle with the help of special plates or screws.
Leg after the operation is placed in a plastic splint or specialized plaster and placed on a small hill for a few days.
Full recovery time after surgery is about 2-3 months. By the way, in this case, the patient is shown to wear special orthopedic shoes. Which minimizes stress on the metatarsophalangeal joint.
It is important that after the operation, the joint regains its mobility.
Used anesthesia during surgery
When carrying out a spinal fusion, we use two types of anesthesia:
- General anesthesia – immersion in the anesthetic sleep;
- spinal anesthesia – sedation and complete analgesia to the lower body of the patient, during which he was fully aware of what is happening.
The time of the operation varies depending on its complexity – from 2 to 5 hours.
Usually, postoperative rehabilitation period lasts from three months to a year.
In addition, for more effective recovery of the supporting ability and to learn to walk after arthrodesis of the joints the patient is assigned to a number of events.
The most common among them:
- physiotherapy or physical education;
- the adoption of the appointed medicines.
You must also conduct ongoing monitoring and systematic examination of the joints that were exposed to operations in a strictly specified physician time.
As a rule, the quality of the arthrodesis does not entail complications.
However, the patient, whose joints were exposed to surgical intervention is need to pay special attention, if during the rehabilitation period he:
- increases temperature;
- sudden pain that cannot be localized even when taking painkillers;
- occurs numbness or persistent tingling;
- the limb takes on an unnatural bluish or grayish hue;
- vomiting or shortness of breath not related to a heart disorder;
- the bandage is stained brown.
All of this can be a signal of suddenly arisen complications:
- thrombosis of blood vessels;
- infection of bones or joints during the operation;
- damage to the nerves.
In addition to the category of complications includes changing gait. In some cases, re-appointed operation.
Despite the complexity of the surgical method of fixation of a joint, the artificial immobilization is sometimes the only way to avoid debilitating pain, pathological deformation of the joint.
But the most important thing is that it is an effective ability to restore the lost supporting function of the paretic limb.