SPINAL FUSION

Quick Overview: 

Spinal fusion is a surgery in which a diseased or damaged spinal disc is removed and the spinal bones (vertebrae) above and below it are fastened together in the hopes that they will fuse into one solid bone. Spinal fusion is a good option for people who need spinal disc surgery but are not candidates for artificial disc replacement. Because it takes time for the spinal bones to fuse together, it may take as long as six months (or more) to fully recover from spinal fusion surgery.

Spinal fusion is used to treat:

• Instability of the spine
• Spinal bone infection
• Spinal bone trauma/fracture, i.e., injury to the spinal bone
• A tumor in the spine
• Abnormal curvature of the spine, e.g., some cases of severe scoliosis or kyphosis
• Mechanical or discogenic pain 
• Degenerative disc disease that causes long-term symptoms 

Are there any risks to spinal fusions? 

• With any surgery, spinal fusion carries a small risk of bleeding, infection, nerve damage, blood clots, and poor wound healing.
• In some cases, the spinal fusion will not “take,” which means the bone graft/graft substitute will not form solid bone between the spinal bones. If this happens, a second spine surgery may be needed.
• In some cases, patients may continue to experience pain and dysfunction after spinal fusion surgery. 

Preparing for spinal fusion:

Up to four weeks before your spinal fusion surgery, make an appointment with your primary care doctor for medical clearance. This is a health assessment that will include bloodwork, an electrocardiogram (ECG), and possibly a chest X-ray. Some of your medications may need to be stopped up to two weeks prior to surgery while others should be taken up to and including the day of your surgery. Remember to ask your doctor or surgeon how to manage your medications before surgery.

You should not eat or drink anything from midnight onward on the day of your spinal fusion surgery. Make sure to arrange transportation from the surgical center (you will not be allowed to drive yourself home). It is also best to stock up on groceries, medications, and other supplies before surgery so you will not need to shop afterward.  

About the spinal fusion procedure: 

Spinal fusion can be performed in many different ways. Both cervical and lumbar fusion can be performed using an anterior approach (i.e., from the front of the spine) or a posterior approach (i.e., from the back of the spine). That said, most people who have spinal fusions have an anterior fusion in the cervical spine. In the lumbar spine it’s mixed depending on the problem being repaired. A general description of the spinal fusion procedure is provided below: 

1. Medications are given intravenously and through a breathing tube (i.e., endotracheal tube) to provide general anesthesia. 
2. A vascular surgeon makes an incision in the front of the patient’s body, the side of the neck for cervical spinal fusion, and the side of the abdomen for lumbar spinal fusion.
3. The vascular surgeon carefully moves the abdominal organs and blood vessels to the one side of the body.
4. The spine surgeon then accesses the front of the spine and places a needle into the problematic disc. A special X-ray machine called a fluoroscope takes a picture of the spine to make sure the needle is in the correct intervertebral space.
5. The spine surgeon removes the problematic spinal disc and releases any nerves that may be trapped. If the spinal bone contains a tumor or an infection, surgeons remove the diseased area of bone. Otherwise, the spinal bones are prepared to accept the bone graft material.  
6. The spine surgeon places two or more substances in the intervertebral space (space between the spinal bones) that the body will use to make more bone. These substances may include a scaffolding on which new bone forms and bone graft and artificial bone graft substitutes. 
7. Since it will take weeks for the bone graft to knit together, the spinal bones are held in place with instrumentation, such as screws, rods, and plates.

Recovering from Spinal Fusion

For full recovery, the spinal bones need to fuse completely after spinal fusion surgery. This process can take months. During spinal fusion recovery, you will need to restrict certain activities for certain lengths of time. For instance, you should not drive, lift anything heavier than 5 or 10 pounds, or engage in sexual activity for the first one to two weeks after surgery, i.e., until your receive approval from your surgeon, usually at the first follow-up appointment. Walking is okay—even encouraged—but don’t engage in any exercise that makes you sweat or breathe so heavily you can’t have a conversation. 

One of the best ways to recover from spinal fusion is to work with a physical therapist. Your physical therapist can help you get around safely while helping you to build strength and stamina. Try to get proper nutrition (good calories, vitamins, minerals, fluids) and avoid non-steroidal anti-inflammatory drugs.

Considering Spinal Fusion? Have you considered an Artificial Disc Replacement?

Artificial disc replacement, also known as intervertebral disc arthroplasty, total disc replacement, or spine arthroplasty, is a spine surgery procedure to replace a diseased or damaged intervertebral disc with an artificial joint. A qualified spine surgeon removes the problem disc and places a metal or metal-and-plastic mechanical device between the vertebrae (individual bones of the spine).

The goal of artificial disc replacement is to relieve chronic back pain. Artificial disc replacement is an excellent alternative to spinal fusion surgery for certain patients. The artificial disc allows the spine to have much greater mobility than can be achieved with spinal fusion surgery.

Get in touch with Dr. Lanman

Dr. Lanman is a board-certified neurosurgeon, fellowship-trained in spine surgery. He has performed hundreds of spinal fusion surgeries in his 30-year career. Most of the patients Dr. Lanman sees do not need surgery but benefit from conservative management, injections, physical therapy, or other non-surgical treatments. However, when you need an artificial disc replacement or spinal fusion surgery, Dr. Lanman has the skill and expertise to expertly perform the procedure.