Maybe your back is hurting more than ever. Perhaps you saw a doctor or a specialist who recommended minimally invasive treatments, but those haven’t cut it. Then your doctor suggests spinal fusion surgery to relieve your chronic back pain. Sounds a little scary, right?
Spinal fusion surgery is a treatment performed by a spine surgeon that permanently fuses two or more vertebrae in the patient's spine reducing any excess motion within them that causes the patient chronic back pain.
According to specialists at the Mayo Clinic, “Spinal fusion involves techniques designed to mimic the normal healing process of broken bones. During spinal fusion, your surgeon places bone or a bone-like material within the space between two spinal vertebrae. Metal plates, screws, and rods may be used to hold the vertebrae together, so they can heal into one solid unit.”
Spinal fusion surgery is ordinarily an innocuous medical treatment but, just like any other surgery, spinal fusion surgery does carry potential risks. Exceeding the immediate dangers of this (and any) surgery, spinal fusion surgery, according to the doctors at the Mayo Clinic, immobilizes parts of the patient's spine, changing the way the patient's spine moves. This places additional stress and strain on the vertebrae above and below the fused portion, and may increase the rate at which those areas of the spine degenerate.
The additional strain can actually expedite age-related wear and tear on the vertebral joints — either side of the fusion — which can generate more damage and cause chronic pain. For some patients, a spinal fusion may be the only option, however, that patient must be aware that there are severe risks when undergoing a spinal fusion.
What are the Risks of Spinal Fusion Surgery?
- Blood clots
- Injury to blood vessels or nerves in and around the spine
- Pain at the site where a bone graft was taken
- Poor wound healing
What Conditions Does Spinal Fusion Surgery Treat?
- Broken vertebrae: Not every broken vertebra needs spinal fusion surgery. Numerous cases in chronic back pain patients have been seen where they heal naturally. However, if a broken vertebra causes the patient's spinal column to become unbalanced, this surgery may be a medical necessity.
- Deformities of the spine. A spinal fusion can improve any spinal deformities, such as a sideways curvature of the spine (scoliosis) or abnormal rounding of the upper spine (kyphosis).
- Spinal weakness or instability: If there's abnormal or excessive motion between two vertebrae, the patient's spine may become unstable, which is a common side effect of severe arthritis in the spine in addition to spinal stenosis — a narrowing of the spinal canal. This surgery, in those cases, can restore spinal stability.
- Spondylolisthesis. In this spinal disorder, one vertebra slips forward onto the vertebra beneath it. Spinal fusion may be needed to treat spondylolisthesis if the disease produces relentless back pain or nerve crowding that can cause leg pain or numbness to the chronic back pain patient.
- Herniated disc: This method can be employed to stabilize the spine after removal of a damaged (herniated) disc.
Patients go under general anesthesia. Spinal surgeons then begins working on the damaged area.
Normally, spinal fusion surgery involves:
- Incision: To secure passage through the fused vertebrae, the patient's surgeon creates an incision either on the patient's abdomen or throat, which is known as anterior approach spine surgery and is thought to be muscle sparing.
- Disc preparation: Interbodies that fuse two vertebrae together may actually come from a bone bank from the patient's own body, commonly from the patient's pelvis or doctors can opt to use fully synthetic (plastic or metal) parts. If the patient's bone is applied, the surgeon makes an incision above the pelvic bone, extracts a small portion of it, and then closes the incision up. In selected situations, some specialists employ a synthetic substance instead of bone grafts. These synthetic substances are thought to further promote bone growth and expedite the fusion of the patient's vertebrae.
- Fusion: To permanently fuse the vertebrae together, the spine surgeon places the chosen interbody material between the vertebrae. Metal plates, screws, or rods may also be used to further hold the vertebrae together while the bone graft recovers.
Caption: Illustration showing hardware (metal) is used to fuse the patient's spine from the back of the neck.
Patients are required to stay at the hospital two to three days following spinal fusion surgery depending on the location of and extent of the surgery. The patient may also feel varied pain and strain, which can be controlled with prescription medicine.
Once the patient returns home, recovery begins. While recovery tends to go smoothly, infection can happen. Signs of infection include: fever higher than 100 F (38 C), redness, tenderness, or swelling, shaking chills, and wound drainage.
It can take months for the bones in a patient's spine to completely heal. The operating physician may recommend wearing a brace for a short time in order to keep the patient's spine aligned correctly. In addition, physical therapy can re-teach chronic back pain patients how to bend, sit, rise, and walk in a safe fashion to prevent re-injury.
Spinal fusion surgery is normally an effective treatment for fractures, deformities, or instability of the spine. However, studies have mixed reviews if the cause of the patient's chronic back or neck pain is unclear. In those cases, this operation is no more effective than non-surgical treatments for non-specific back pain. Before proceeding with spinal fusion, ask your doctor about other options, like artificial disc replacement, or seek a second opinion from another specialist. Once you have the information you need to make the right decision for your back, tell us what happened.