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New approach to pain control during spinal fusions

Ron I. Riesenbuger, MD is a neurosurgeon at Tufts Medical Center.

Spinal fusion is one of the most common types of back surgery performed at Tufts Medical Center, in Boston and across the country. In the Spine Center at Tufts MC, our surgeons complete three to four spinal fusions each week and have recently found a new way to help patients have a faster, less painful recovery. 

We asked Director of the Spine CenterRon Riesenburger, MD and Co-Chief of the Division of Spinal Surgery at Tufts Medical Center, James Kryzanski, MD, about this new technique and what patients can expect when undergoing a spinal fusion at Tufts MC.  

What is a spinal fusion? 

A Spinal fusion is a procedure where two or more vertebrae are “welded” together to strengthen the spine and prevent motion in areas of pain. At Tufts MC, we perform minimally invasive spinal fusions, which means we make a much smaller incision, allowing for quicker recovery and less pain. 

Spinal fusions most often involve people over 40 who end up with painful degenerative diseases of the spine as they age. And the procedures are on the rise as the population of baby boomers has become older. From 2001 and 2011, spinal fusions increased by 70 percent in the United States. 

What is different about the spinal fusion approach at Tufts MC? 

Because we make such a small incision, the procedure lends itself toward a type of treatment that numbs the area and keeps it numb for a few days. Just as the surgery is being completed, we inject a dose of a non-narcotic analgesic called Exparel into the muscles around the incision area.

It numbs the area like Novacaine does for dental procedures, but works for a longer period of time. The medication is encapsulated in microscopic spheres that release the drug over time. It wears off slowly, over the first 24-48 hours after surgery and it relieves the pain of the incision, which can be quite intense post-procedure.

James Kryzanski, MD is a neurosurgeon at Tufts Medical Center.Has this new approach to pain control been tested? 

We, along with our anesthesiology colleagues Penny Liu, MD and Adriana Desilier, MD tested the effectiveness of the injections on pain control using 74 patients – half who received the drug with their spinal fusion and half who did not.

We found that on average, patients who had the medication had a 20 percent pain reduction in the 24 hours following the procedure and required 33 percent less narcotic medication. Our results are published in the July 2016 edition of World Neurosurgery

What are the benefits of this new approach? 

Patients who have narcotics for their pain management are slower to mobilize after surgery and these drugs can cause a host of side effects including vomiting, constipation and sleepiness. This injection is not a narcotic and the medicine is placed right at the site of the pain.

Also, in our study, we found that patients who had the injection lessened their hospital stay by about a day. So, not only do patients get home or into rehabilitation faster, taking this simple step saves the healthcare system money.