Spinal fusion surgery is a procedure that involves joining two or more vertebrae together in the spine. This is typically done to alleviate pain caused by conditions such as spondylolisthesis, scoliosis, or spinal fractures. During the surgery, the surgeon will use bone grafts and/or metal hardware (such as screws and rods) to hold the vertebrae in place while they fuse together during the healing process. The goal of the surgery is to stabilize the spine and reduce pain and nerve compression. Recovery time can vary, depending on the specific procedure and the patient’s overall health but can be weeks to months.
What is a spinal fusion?
A spinal fusion surgery is a procedure that joins two or more vertebrae in the spine in order to stop them from moving separately. This procedure is typically done to alleviate pain caused by conditions such as spondylolisthesis, degenerative disc disease, scoliosis, or spinal fractures.
During the surgery, the surgeon will remove any damaged or diseased disc material and then use bone grafts and/or metal hardware (such as pedicle screws, rods, and cages) to hold the vertebrae in place while they fuse together. The bone grafts can be taken from the patient’s own body (autograft) or from a cadaver (allograft), or synthetic materials can be used as well. The metal hardware is used to keep the spine stable as the vertebrae fuse together.
The goal of the surgery is to stabilize the spine and reduce pain and nerve compression.
Which conditions are treated with fusion?
Spinal fusion surgery is typically indicated for conditions that cause pain or instability in the spine. Some common indications for the surgery include:
- Degenerative disc disease: This is a condition in which the discs between the vertebrae begin to wear down, leading to pain and instability in the spine.
- Spinal fractures: Fractures in the vertebrae can cause instability and pain in the spine.
- Spondylolisthesis: This is a condition in which one vertebra slips forward over another, which can lead to instability, nerve compression and pain.
- Scoliosis: This is a condition in which the spine is curved to one side. This can lead to uneven pressure on the vertebrae and cause pain. A fusion surgery is often used to correct the deformity from scoliosis.
- Tumors: Spinal tumors can cause pain and instability, especially if they erode through vertebrae.
- Instability from Surgery: A fusion surgery is sometimes needed to stabilize the spine after a decompression surgery such as a laminectomy.
Different types of spinal fusion
There are several different types of spinal fusion surgeries. Each is used based on the region of the spine affected and the condition being treated.
Interbody fusion
Interbody fusion is a surgical procedure that involves the removal of the intervertebral disc from the disc space in the spine. After the disk space has been cleared, the surgeon will place a spacer, commonly made of metal, plastic, or bone, between the two adjacent vertebrae. This spacer, also known as a “cage,” typically contains bone graft material, which helps to foster bone healing and encourage the fusion of the vertebrae.
Posterior lumbar interbody fusion (PLIF)
This procedure is used to treat conditions in the lumbar region of the spine. The surgeon accesses the spine through an incision in the back.
This approach allows the surgeon to work on the spine from the back and maintain the stability of the spine by preserving the muscles and nerves that run along the back of the spine. This procedure is often chosen for patients with smaller or less complex disc herniations, or for patients who have had previous spinal surgery.
Anterior lumbar interbody fusion (ALIF)
The anterior lumbar interbody fusion (ALIF) procedure is also used to treat conditions in the lumbar (lower) region of the spine. The surgeon accesses the spine through an incision in the abdomen, rather than the back, and the disc is removed and replaced with a bone graft.
The benefit of this approach is that it allows the surgeon to work on the spine from the front, avoiding damage to the muscles and nerves that run along the back of the spine. This procedure is often chosen for patients with larger or more complex disc herniations, or for patients who have had previous spinal surgery.
Transforaminal lumbar interbody fusion (TLIF)
The transforaminal lumbar interbody fusion (TLIF) procedure is also used to treat conditions in the lumbar region of the spine. The surgeon accesses the spine through an incision in the back and through a small incision on the side of the spine to access the disc.
One benefit of this method is that it involves less displacement of the nerve roots, which potentially reduces the risk of nerve damage. This procedure is often chosen for patients with smaller or less complex disc herniations, or for patients who have had previous spinal surgery.
Anterior cervical discectomy and fusion (ACDF)
Anterior cervical discectomy and fusion (ACDF) is a type of spinal fusion surgery that is used to treat in the cervical (neck) region of the spine. The surgery is performed through an incision in the front of the neck, and the surgeon accesses the spine directly from the front, which is called anterior approach.
Thoracic fusion
This procedure is used to treat conditions affecting the thoracic (middle) region of the spine. The surgeon accesses the spine through an incision in the back. This procedure is often chosen for patients with scoliosis, kyphosis, or fractures of the thoracic spine.
What is the recovery time following a fusion?
In most cases, you can expect to spend 1 to 3 days in the hospital following a fusion surgery. The duration of your stay will depend on your level of pain control and your ability to move around.
It is common for patients to begin standing and walking the day after surgery. Your surgeon may give you a back brace to help you feel more comfortable and to protect the surgical fusion.
During the first several weeks after the surgery, you should be able to perform basic exercises like walking but should avoid activities such as bending, twisting, or lifting heavy objects during this time.
Most patients who undergo a fusion procedure can anticipate an improvement within weeks to months after the surgery.
What are the risks of a spinal fusion?
As with any complex operation, there are several risks associated with spinal fusion surgery. Some of these risks include:
- Infection: Although surgery is performed in sterile conditions, there is always a small risk of infection at the surgical site.
- Nerve damage: Nerves in and around the spinal cord can be damaged during the surgery.
- Damage to other surrounding tissues: Other tissues as well as blood vessels and organs can be damaged during the procedure.
- Non-union: The vertebrae may not fuse together properly, which may require additional surgery.
- Adjacent segment disease: Adjacent segment disease can occur when the segments of the spine above or below the fused area become damaged or degenerate.
- Hardware complications: There is a risk that the hardware used to fuse the vertebrae together may become loose or cause irritation.
Is a spinal fusion right for me?
It’s important to consult with a qualified spine surgeon to determine if spinal fusion surgery is the right option for you.
There are many factors to be considered, including the specific condition being treated, your overall health, and your goals and expectations.
It’s also important to note that spinal fusion surgery is not always the best option for everyone. Some patients may be better served by other treatments, such as physical therapy, medications, or minimally invasive procedures.
