FAQ - BAK fusion surgery

Q :		What does the term BAK fusion mean?
A :		BAK fusion means that the vertebrae in the back are being joined by a bone graft from one vertebra to another over one or more levels, the purpose of which is to eliminate motion between those particular vertebrae. The theory is that the motion of one vertebra on the other causes pain at that particular level. Frequently back pain is caused by a pain generator at one particular level in the spine. If the motion at that particular level can be eliminated, the pain can be eliminated. BAK fusion was named after the two surgeons who developed the technique. BAK fusion technique differs from others in that the disk space which is almost always collapsed or narrowed in degenerative disk disease is re-elevated and kept in place by the installation of titanium cages which are packed with bone allowing fusion to occur from one vertebra to another. This eliminates motion of the one vertebra on the other, and relieves nerve root compression caused by the collapse of the disk space.

Q :		What does discogenic pain mean?
A :		Discogenic pain means that back pain is coming from one particular disk. The term discogenic pain more or less precludes pain from a “ruptured disk.” Ruptured disks may cause both back pain and leg pain. Discogenic pain implies only back pain, and does not include a ruptured disk. Many people who undergo back surgery for herniated disks, unfortunately continue to have discogenic pain.

Q :		What is a disk or an intervertebral disk?
A :		An intervertebral disk is the space between two vertebrae. It is comprised of two parts. The outer part, the annulus fibrosis, is a circular ligament, which holds the two vertebrae together. The inner part called the nucleus pulposus or the nucleus of the disk is a spongy material which acts like a cushion to permit motion between the two disks. The annulus or circular ligaments job is to keep the nucleus in its’ proper position centered between the vertebrae. If the circular ligament between the vertebrae fails in some way, is torn, or degenerates, it may allow the disk material which is under constant pressure to escape or rupture. This not only allows the disk space to collapse, but the disk material which ruptures may cause pressure on the nerves which are located directly behind the vertebrae and go into the legs. This causes sciatica or leg pain due to nerve root pressure.

Q :		If BAK fusion is for back pain, why is it done from the front?
A :		The modern tendency is for BAK fusions to be done from the front because it decreases the time of the operation and eliminates the production of scar tissue around the nerves and muscles of the back. The technique involves doing the surgery through a small transverse incision in the left lower abdomen around the outside of the peritoneal sac conaining the organs, completely eliminating the need to go through the abdomen. This makes the recovery time faster and the complications are fewer using this technique.

Q :		How long would I be in the hospital for BAK surgery?
A :		The length of hospitalization varies by individual patients needs and the number of levels which undergo surgery. Patient’s can return home if temperature is normal, eating and drinking can be accomplished, and ambulation can be performed satisfactorily. Usually three to five days is an adequate period for hospitalization.

Q :		What needs to be done in preparation for BAK fusion surgery?
A :		A back brace is necessary to be custom fabricated prior to fusion surgery. This protects the fusion levels for the several months immediately after surgery to allow the fusion the best opportunity to occur. Also, we advise people to donate one to two units of their own blood so that if blood is necessary after surgery, any complications with transfusion are avoided.

Q :		How much pain could I expect to have after surgery?
A :		Discomfort after surgery is minimal compared with the amount of pain which most patients have had for months or years prior to this procedure. For the first several days, discomfort can be easily controlled with patient controlled anesthesia, which is a narcotic pump attached to the intravenous line through which the patient can administer their own anesthesia with a push of a single button. After several days, the need for medication is minimized, and can be easily be controlled with oral medications. Usually, the surgery itself will decrease the previously existing back pain markedly leaving only the incisional discomfort after surgery.

Q :		How do I know if I need BAK surgery?
A :		BAK fusion is usually for people who have had long term back pain, many of whom have had other operations for removal of disks or failure of other forms of treatment. MRI scans and other tests can usually tell whether BAK fusion surgery has a good chance of solving the back problem. Other procedures usually are employed to relieve back pain before considering this form of surgical treatment.

Q :		How can I get more information about BAK fusion surgery?
A :		Each individual presents special problems and considerations, and it is probably necessary to have an office visit and consultation with the physician to determine whether or not one might be a good candidate for BAK fusion surgery.