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Spinal Fusion: The way back to self

Written and Photographed By: Natalie Youssef Advancements in spine surgery are happening all the time and they are a hot topic in my household. My father, Jim Youssef, is a spine surgeon in Durango, CO while my mother, Melissa Youssef, has struggled with spine issues throughout her life. It was traumatic for a 14 year old girl about to start high school to wear this brace, says my mom. After 13 awkward months of wearing a back brace, my Mom was informed that her back brace hadn’t corrected her scoliosis and she needed surgical intervention. “I was devastated,” my mother said. My At the age of 14 my mother was scared at the Melissa Youssef Surfing 2013 mother found out that time and dreaded the she had severe moment she would be put scoliosis and needed to sleep and wake up with to wear a brace. a rod in her back starting Scoliosis is a disorder from the neck all the way of the spine, in which down to her tailbone. My there is a sideways Smother is still haunted by shaped or C-shaped the memories of the curve. According to nurses turning my mother the National Institute over so she wouldn't get of Health, idiopathic bedsores. scoliosis, occurring spontaneously from an unknown cause, is the most common type “It was always an excruciating experience” among young teens and is most common in my Mom remembers. After months of girls, which is the type my mother had. Data recovery including a month in the hospital, from the National Institute of Health states her life was beginning to go back to normal. that According to a publication by the Scoliosis Foundation in 2009, approximately Later, when she was a married, mother of 1 in 40, or about 7 million people in the US three, in her forties, she noticed a strange are afflicted by scoliosis. In most cases of twinge in her lower back. “The pain got scoliosis, the cause is unknown. As stated worse and worse over time until it finally by the National Institute of Health, scoliosis became overwhelming and was affecting can be genetic, and does seem to run in my quality of life. I could no longer do things families. Children who have relatives with that I liked to do” my mother says. scoliosis should have regular screenings for the condition. According to my father, my mom’s lower back was completely worn out, causing her My mother’s scoliosis was spotted by her nerves to compress every time her lower mom while they were in a dressing room back moved. and required immediate treatment. My mom needed a XLIF, which stands for “Before I could really comprehend what was Extreme Lateral Interbody Fusion. As the happening, I was being fitted for a brace name suggests, this is an incredibly that I would have to wear continuously for invasive and involved surgical procedure. the next 13 months. I only took it off to This spinal fusion involves correction of shower and swim” expresses my Mom. deformed parts of the spine by joining two or more vertebrae using implants such as screws, rods and cages. 1|Page

The National Center for Biotechnology Information (NCBI) has extensive information about spinal fusion and materials used in the process. Spinal fusion is an incredibly complex procedure involving biomaterials. Screws, rods, and cages are inserted in the spine to correct deformities and the material these implants are made from is critical to success of the procedure. Natural bone fuses with implants to create a well-aligned spine. There are three different categories of materials that have been used for orthopedic implants: metals, polymers, and ceramics. My mom underwent anterior-posteriorlumbar fusion and had four titanium screws, two rods placed within her spine and a cage between her L2 & L3 vertebrae to correct the malformation. The “L” stands for lumbar, which is the lower back. The numbers refer to the position of the vertebra in relation to tailbone. The higher the number, the lower on the back the vertebra is. In 2008, when my mom had her procedure, Titanium was the bio-material of choice. However, Titanium implants are now being used less and less as the Silicon Nitride, a ceramic, becomes the norm. According to the NCBI, Silicon Nitride started to be used in 2009 for spinal fusion procedures and has proven to be tremendously superior to previously used materials and greatly improves post-operative success. According to a study published by the NCBI in 2012, infection rates among patients who have undergone spinal surgery range from 1% to 12%. Bacterial infections are a serious concern for any surgery. This threat is heightened as the complexity of the surgery increases. The risk of post-operative infection is increasing due to the emergence of antibiotic resistance and the quick speed at which bacteria penetrate wounds developing biofilms on implants, says the North American Spine Society. 2|Page

This 2012 NCBI study, found live bacteria around 21% of Titanium implants and none of the Silicon Nitride implants showed bacterial growth. In addition, the Silicon Nitride implants showed significantly superior fusion with the bone than Titanium implants. Silicon Nitride is more hydrophilic than Titanium. This may be why Silicon Nitride is less likely to be infected by bacteria, according to the NCBI report. This is because the more water loving the material the more effectively the implant will become one with the body because it affects protein adsorption and conformation. Another reason is because Silicon Nitride has a net positive charge due to the presence of nitrogen-based amine groups on the surface. This positive charge disrupts the membranes of negatively charged bacteria and prevents them from surviving. Luckily my mom’s procedure went off without a hitch and got her back on her feet. “The recovery was difficult but after a couple of months I regained my strength and began to have my normal quality of life back with sports, daily activities, and no pain,” said my mom. Five years after her surgery, my mom is still doing great! Her spinal fusions surgery has been a great success and has allowed her to keep up with her three kids, ski, hike, surf, and serve her community in a variety of ways. The advice my mom offers is, “Do your research so that you can understand what the procedure will entail and what your options are. Having my husband perform the surgery brought me a great deal of comfort because I was able to ask him lots of questions. Spinal problems can be extremely painful and interfere with your life’s path. Although scary, spinal surgery can be the solution for a pain-free life.”