Spinal fusion surgery is a procedure in which two or more vertebrae are fused together to form a single bone structure. Spinal fusion surgery has been performed for many decades and modern technology and technique have made the procedure more successful and less invasive than ever before. Ultimately, the goal of spinal fusion surgery is to stabilize the affected vertebrae to relieve pain and prevent additional degeneration.

Reasons for performing a spinal fusion surgery

Many painful conditions of the spine can be improved with spinal fusion surgery. Some of the most common conditions for which spinal fusion surgery is employed are:

• Lumbar degenerative disc disease
• Lumbar spondylolisthesis (isthmic, degenerative, or post-laminectomy spondylolisthesis)
• Injury to the spine
• Misalignment of the vertebrae
• Spinal stenosis
• Herniated disc
• Rheumatoid arthritis
• Infections, tumors, or spinal deformities
• Weakness or instability of the spine
• Scoliosis
• Deformity

How the procedure works

Your surgeon will access the spine either from the front though the lower abdomen (anterior approach), from the back (posterior approach) or from the side (lateral approach). Depending on each patient’s circumstance, the surgeon will determine which approach represents safest and most effective option.

During surgery, bone material will be grafted to the vertebrae to promote bone production and a solid connection. There are several ways to harvest the bone needed for the fusion procedure:

• An autograft involves bone material that is harvested form the patient’s own body – usually the hip. This is performed during surgery and requires an additional incision. While using the patient’s own bone material is ideal, it causes additional pain and recovery time due to the added surgical procedure.
• An allograft is bone material harvested from a cadaver.
• Artificial materials such as bone morphogenic materials or BMPs and ceramics may be used instead of human bone with excellent results.

The bone graft stimulates the body to grow more bone between the vertebrae, thus creating the spinal fusion. The material used for the bone graft will be discussed during consultation and after reviewing relevant diagnostic results.

The surgeon may opt to immobilize the spine with internal fixation – plates and screws in the bone that increase stabilization of the surgical area. Doing so may offer the additional support needed for better results and a faster return to normal activity.

Recovery and aftercare

Immediately after surgery

The recovery from spinal fusion surgery requires the patient to learn appropriate posture and alignment of the spine to ensure the very best results. During this time, especially in the first few months after surgery, patients will need to limit their range of motion and activity levels even though they will likely start feeling better early on after surgery.

Rehabilitation and physical therapy will begin soon after surgery and will promote proper alignment and build muscle that is critical to supporting the vertebrae.

Pain management is important and patients may be prescribed both non-opioid and opioid medications after surgery. We encourage patients to transition from opioid to non-opioid medication as soon as the pain level drops to a tolerable level.

Longer-Term

As patients begin to regain range of motion they will be able to perform many of the activities that they could before surgery, albeit with some limited range of motion. Usually, because only a small number of vertebrae are affected by the fusion, the limitations are minor and the patient will get used to them quickly.

It will also be important for patients to improve their lifestyle habits including proper diet and exercise to lose weight and build supportive muscle tissue.

Risks of spinal fusion surgery

Depending on a patient’s health circumstance and the complexity of the procedure, there are risks that must be considered.

Spinal fusion surgery is major surgery that comes with all the risks inherent to any procedure. These can include excessive bleeding, pain and infection. Patients will work closely with their surgeon, both before and after surgery, to minimize the chance of these complications.

Because of the very nature of the spine, not all spinal fusion will be successful. The experience of the surgeon and surgical team as well as adherence to the aftercare program will minimize the potential for failure.

Patients will have to adhere to a strict change in movements including limiting activities and restricting some movements. If patients do not follow these guidelines, they risk failure of the procedure.

Because of the length of the procedure and reduced movement after surgery, blood clots are an uncommon, but possible, complication. Be sure to follow post-operative instruction closely to avoid blood clots.

As with any major surgical procedure, we employ a comprehensive preoperative testing regimen to ensure the most effective and safe procedure for each patient. During consultation, patients will be apprised of the risks of surgery and will make the decision as to whether surgery is appropriate with the advisement and help of their surgeon.