Spinal Fusion Procedure
Overview
Spinal fusion surgery connects two or more bones in the spine, called vertebrae. The goal is to stop these bones from moving against each other, which can help reduce pain.
Surgeons often use bone material along with metal devices such as plates, screws, or rods to keep the bones stable as they heal. Some procedures use minimally invasive techniques (MISS) for smaller cuts and faster recovery.
Key Details:
- Connects two or more vertebrae.
- Uses bone or bone-like material.
- Often includes metal support devices.
- Can use minimally invasive methods.
Reasons for Spinal Fusion
Surgeons perform spinal fusion to address several spine issues. The procedure strengthens the back by permanently joining two or more vertebrae. This stabilizes the spine when there is weakness or too much movement between the bones, often caused by arthritis.
Common Conditions Treated with Spinal Fusion
- Scoliosis: Curving of the spine to the side.
- Spondylolisthesis: One vertebra slips over another.
- Degenerative Disc Disease: Discs break down, leading to pain.
- Spinal Stenosis: Narrowing of spaces within the spine.
- Herniated Disc: Damaged discs needing removal.
- Tumors or infections causing instability.
- Ligament damage that weakens the spine.
By securing the vertebrae together, surgeons help reduce back pain and prevent further damage.
Possible Dangers
Spinal fusion and disc replacement surgery can cause some risks. These include infection, bleeding, or poor healing at the surgical site. Blood clots or nerve damage around the spine can occur. Sometimes, bone grafts from a bone bank do not fully heal, causing pseudarthrosis. Symptoms can also return after the procedure.
How You Get Ready
Before surgery, medical staff clean the area where the surgeon will work with a special soap, and may trim hair. Patients should share a list of current medicines with their doctor, as some drugs may need to be stopped shortly before the operation. They may need general anesthesia, and sometimes an MRI helps plan the surgical approach.
What You Can Expect
What Happens in the Operating Room
Doctors perform spinal fusion surgery while the patient is fully asleep with general anesthesia. The surgical approach varies based on the part of the spine being treated and the person’s needs. Main approaches include:
- From the Back (Posterior Lumbar Interbody Fusion, PLIF): The surgeon makes a cut in the back or neck directly over or beside the spine.
- From the Front (Anterior Lumbar Interbody Fusion, ALIF): The surgeon reaches the spine through the belly or throat.
- From the Side of the Spine (Transforaminal Lumbar Interbody Fusion, TLIF): The surgeon accesses the spine through a small incision in the back, angled slightly to the side, allowing access to the disc space without moving nerve structures too much.
- From the Side (Direct Lateral Interbody Fusion): The surgeon makes the incision on the side of the body.
To help the bones grow together, doctors use a bone graft. The graft can come from the patient’s own body (often the pelvis), a donor (allograft), or be created from special man-made materials. If using the patient’s own bone, the surgeon makes a small cut near the hip to collect the material.
Once the graft is ready, the surgeon places it between the vertebrae that need to be joined. Special hardware like screws, rods, and metal plates (known as instrumentation) serve as an internal cast to keep the bones together while the fusion takes place. The type of spinal fusion may affect exactly where these are used.
| Approach | Where incision is made | Common hardware used |
|---|---|---|
| ALIF | Belly | Screws, rods, cages |
| PLIF | Back | Screws, rods |
| TLIF | Back, side of spine | Screws, rods, spacers |
| Direct Lateral | Side | Screws, rods, cages |
What to Expect Following Surgery
Most people stay in the hospital for two or three days after their spinal fusion. Some pain or discomfort is common, and pain medication helps manage it. Patients should watch for possible signs of infection. Redness, swelling, or drainage from the wound, as well as fever or chills, should be reported to a healthcare provider.
At home, surgeons often recommend wearing a brace to help keep the back stable. Healing is slow, and bones may take months to fully join together. Physical therapy plays an important role in recovery. Therapists teach patients safe ways to move, stand, and walk to support the healing of their spine. Recovery steps might include:
- Taking pain medicine as prescribed
- Watching the incision for changes
- Using a brace if given
- Following physical therapy exercises
- Avoiding heavy lifting until cleared by the doctor
A neurosurgeon or orthopedic specialist and their team oversee this process to ensure the spine heals well. In some cases, a lumbar laminectomy, decompression, or discectomy may also be part of the surgical plan. These steps help relieve pressure on nerves before the fusion.
Findings
Many people have less pain and improved stability after spinal fusion, especially when surgeons perform it for broken bones or to correct problems with spine alignment. Some patients may also find it easier to do daily activities as a result of the surgery.
| Benefit | Possible Problem |
|---|---|
| Less pain | Increased stress nearby |
| Better stability | Possible need for more surgery |
However, when the reason for back or neck pain is not clear, this surgery often does not work much better than other treatments that do not involve surgery. Spinal fusion cannot stop new pain from developing in the future, since it does not fix conditions like arthritis.
