Advancements in spine surgery are happening all the time and they are a hot topic in my household. My father, Jim Youssef, is a spinal surgeon in Durango, CO, while my mother, Melissa Youssef, has struggled with spine issues throughout her life.

Five years after her spinal fusion surgery, Melissa Youssef is leading an active life. Credit: Natalie Youssef.


At the age of 14, my mother found out that she had severe scoliosis and needed to wear a brace. Scoliosis is a disorder of the spine, in which there is a sideways S-shaped or C-shaped curve.


According to the National Institutes of Health (NIH), idiopathic scoliosis is the most common type of scoliosis among young teens and is most common in girls.


According to the National Scoliosis Foundation, approximately 1 in 40, or about 7 million Americans in 2009 were afflicted by scoliosis. In most cases of scoliosis, the cause is unknown. 


As stated by NIH, scoliosis can be inherited and does seem to run in families. Children who have relatives with scoliosis should have regular screenings for the condition. 


My mother’s scoliosis was spotted by her mom while they were in a dressing room and required immediate treatment.  


“Before I could really comprehend what was happening, I was being fitted for a brace that I would have to wear continuously for the next 13 months, says my mom. “I only took it off to shower and swim.”


“It was traumatic for a 14 year old girl about to start high school to wear this brace,” she says. 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 recalls.


She was scared at the time and dreaded the moment she would be put to sleep and wake up with a rod in her back starting from the neck all the way down to her tailbone. My mother is still haunted by the memories of the nurses turning her over so she wouldn't get bedsores.


“It was always an excruciating experience,” my Mom remembers. After months of recovery including a month in the hospital, her life was beginning to go back to normal.


Later, when she was a married, mother of three, in her forties, she noticed a strange twinge in her lower back.


“The pain got worse and worse over time until it finally became overwhelming and was affecting my quality of life. I could no longer do things that I liked to do,” my mother says.


According to my father, my mom’s lower back was completely worn out, causing her nerves to compress every time her lower back moved.


My mom needed a XLIF, which stands for Extreme Lateral Interbody Fusion. As the name suggests, this is an incredibly invasive and involved surgical procedure. This spinal fusion involves correction of deformed parts of the spine by joining two or more vertebrae using implants such as screws, rods and cages.  


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 inserted into the spine to correct deformities. 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-posterior-lumbar fusion and had four titanium screws, two rods placed within her spine and a cage between her L2 and 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 vertebra is on the back.


In 2008, when my mom had her procedure, titanium was the material of choice. However, titanium implants are now being used less and less as 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.

This 2012 NCBI study, found live bacteria on around 21% of titanium implants but none of the silicon nitride implants. In addition, the silicon nitride implants showed significantly superior fusion with the bone than titanium implants. 


Silicon nitride is more more “water loving” or 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 hydropillic the material, the more effectively the implant will become one with the body.


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,” says my mom.

Related Story: Scoliosis in My Life


Five years after her surgery, my mom is still doing great! Her spinal fusions surgery has allowed her to keep up with her three kids, ski, hike, surf and serve her community in various 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." Natalie Youssef


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