Spinal Fusion

Spinal fusion is a surgery that joins the spinal bones together so that they can grow into one solid bone. Your doctor may recommend this surgery if you have a spinal injury, pain, or other symptoms due to damage to the spine.

The surgery is usually done to correct instability (abnormal movement) of the spine. Arthritis, injuries, or simple wear and tear can cause some of the bones in your spine to slip or shift out of place. This abnormal bone movement can cause back pain. It can also pinch nerves, causing pain, numbness, or weakness in your legs. The leg pain is called sciatica or radiculopathy. The goal of spinal fusion is to stop abnormal movement and thus eliminate pain in your back and legs.

Spinal fusion has some risks and side effects:

• Blood loss. With any surgery there is always the potential for life-threatening blood loss, but with current techniques this is rare.
• Damage to the nerve sac, with leak of spinal fluid (2 to 5 in 100 cases). If the nerve sac is unintentionally opened during surgery, it will be repaired. This should not have any effect on your long-term outcome, but you may have to spend a day or two flat in bed to allow the repair to strengthen. Rarely, further treatment may be necessary.
• Infection (1 or 2 in 100 cases). Even with antibiotics and careful sterile techniques, there is still a small risk of developing a wound infection.
• Damage to spinal nerves (fewer than 1 in 1000 cases). This could cause ongoing pain, numbness, or weakness in your legs.
• Failure of fusion. If the fusion fails, you may need to have more surgery.
• Failure to relieve symptoms. Your surgeon will do everything possible to give you the best results. Even so, surgery may not relieve all your symptoms.

Spinal fusion is usually done to correct instability of the spine. It may take away pain by stopping abnormal and painful movement between diseased vertebrae. The goal of spinal fusion is to stop abnormal bone movement and thus eliminate pain in the back and legs.

This surgery can help with a number of other conditions, including:

• Scoliosis (skoh-LEE-oh-SIS)
• Herniated discs
• Spinal stenosis (steh-NO-sis)

Take these steps to help your surgery and recovery go better:

• Stop smoking. If you smoke, try to stop prior to surgery. Non-smokers have fewer complications related to surgery. More importantly, smoking slows bone healing and could cause your fusion surgery to fail.
• Stop certain medications. Stop taking aspirin 2 weeks before surgery. Stop taking anti-inflammatory medications such as ibuprofen (Advil, Motrin) and naproxen (Aleve) 1 week before surgery. If you take blood thinners, ask your doctor when to stop taking them. You can continue to take most of your other regular medications. Tell your doctor everything you’re taking so your doctor can help you know what to stop.
• Ask for time off work. Ask your doctor how long you may need to be off work, and make arrangements with your employer.
• Ask for someone to drive you home. Arrange for a responsible adult to drive.
• Do not eat or drink anything after midnight the night before the surgery.

Spinal fusion is done by placing a bone graft between the vertebrae. The graft is made of small pieces of bone. The bone graft may be taken from the patient (autograft) or from a bone bank (allograft). Over time the graft will fuse (grow together) the vertebrae into a solid piece of bone.

The surgeon may reach the vertebrae through the back, from the front, or both. If the fusion is between vertebrae in the neck, the surgeon will usually reach them through the front. Special tools will hold muscle and tissues to the side.

If spinal nerves are pinched by disc material, overgrown joints, or bone spurs, the surgeon will remove that material to ensure that the nerves have plenty of space.

The vertebrae may be held together with rods, screws, plates, or cages. These can keep the vertebrae from moving until the grafts are healed.

This surgery usually takes 2 to 3 hours but may take up to 6 or 7 hours depending on your body and any surgeries that you’ve had before.

Recovery from spinal fusion surgery can take longer than with other types of surgery. Before you can return to your normal daily activities, your doctor needs to see that the bone is healing. This is usually at least 6 weeks after surgery.

You will be able to tell if the surgery worked by seeing how your pain and other symptoms feel after the surgery compared to how they felt before.

Your doctor will schedule a follow-up appointment with you to check how you are doing after the surgery. This may be a few weeks after you are released from the hospital. If you have severe pain, infection, or other serious side effects, you should contact your doctor right away.

• You will feel new pain in the area where the surgery was done. The first few days after surgery can be quite painful. You’ll be given medication for it, and the pain will gradually go away.
• Expect to stay in the hospital between 2 and 6 days. Some patients need to stay longer. You will be allowed to go home as soon as you’re doing well medically and your surgeon approves.
• A short stay in a rehabilitation facility may be advised for people who have had extensive surgery or who are older.
• Your activity will be restricted while you recover. Some people will also need to wear a brace at first.
• Plan to be off work for 4 to 6 weeks if you are healthy and your job is not physically difficult. It can take 4 to 6 months to get back to work if you are older or had more complex surgery.

• North American Spine Society