One of the most Critical Surgery - Spinal Fusion Surgery (Surgery, Complications, Recovery)

Spinal fusion is a surgical procedure used to correct problems with the small bones in the spine (vertebrae). It is essentially a "welding" process. The basic idea is to fuse together two or more vertebrae so that they heal into a single, solid bone. This is done to eliminate painful motion or to restore stability to the spine.

If medicines, physical therapy, and other treatments (like steroid injections) haven't helped your back pain, this surgery might be an option. Doctors usually only recommend it if they know exactly what's causing the problem.

Spinal fusion might help you feel better if your back pain is caused by:

• Degenerative disk disease (the space between disks narrows; sometimes they rub together spaces)


• Fracture (broken spinal bone)


• Scoliosis -- your spine curves abnormally to one side


• Spinal stenosis (narrowing of the spinal canal)


• Spondylolisthesis (forward shifting of a spinal disk)


• Tumors or spine infection

Spinal fusion eliminates motion between vertebrae. It also prevents the stretching of nerves and surrounding ligaments and muscles. It is an option when motion is the source of pain, such as movement that occurs in a part of the spine that is arthritic or unstable due to injury, disease, or the normal aging process. The theory is if the painful vertebrae do not move, they should not hurt.

If you have leg pain or arm pain in addition to back pain, your surgeon may also perform a decompression (laminectomy). This procedure involves removing bone and diseased tissues that are putting pressure on spinal nerves.

Fusion will take away some spinal flexibility, but most spinal fusions involve only small segments of the spine and do not limit motion very much. The majority of patients will not notice a decrease in range of motion. Your surgeon will talk with you about whether your specific procedure may impact flexibility or range of motion in your spine.

To help you understand the main terms and abbreviations regarding spinal fusion, a glossary has been developed: Spinal Fusion Glossary.

How to Prepare?

The week before your surgery, you may have some blood tests and spinal X-rays if you haven't had any recently.
Your health care team will go over the details of your procedure. Don't be afraid to ask questions if you don’t understand something. Your surgeon wants you to be prepared.

Here are some things to think about in the days prior to your surgery:

• Know when to arrive at the surgery center. You’ll need someone to drive you and take you home.


• Get a list of the medicines you can or can’t take in the days before surgery. Some drugs, like aspirin or other anti-inflammatory drugs, may be unsafe. Never stop taking any medicines without your doctor's OK.


• Find out if you can eat or drink anything before your procedure.


• Get your home ready. You’ll need raised toilet seats, shower chairs, slip-on shoes, reachers, and other aids.

Procedure:

Lumbar and cervical spinal fusion have been performed for decades. There are several different techniques that may be used to fuse the spine. There are also different "approaches" your surgeon can take to reach your spine.

Your surgeon may approach your spine from the front. This is called an anterior approach and requires an incision in the lower abdomen for a lumbar fusion or in the front of the neck for a cervical fusion. (Related Article: Anterior Lumbar Interbody Fusion)

A posterior approach is done from the back. (Related Articles: Posterolateral Lumbar Fusion and Posterior Lumbar Interbody Fusion and Transforaminal Lumbar Interbody Fusion)
In a lateral approach, your surgeon approaches your spine from the side. (Related Article: Lateral Lumbar Interbody Fusion)

Minimally invasive techniques have also been developed. These allow fusions to be performed with smaller incisions.

The right procedure for you will depend on the nature and location of your disease.

 

Bone Grafting

All spinal fusions use some type of bone material, called a bone graft, to help promote the fusion. Generally, small pieces of bone are placed into the space between the vertebrae to be fused.

A bone graft is primarily used to stimulate bone healing. It increases bone production and helps the vertebrae heal together into a solid bone. Sometimes larger, solid pieces are used to provide immediate structural support to the vertebrae.

In the past, a bone graft harvested from the patient's pelvis was the only option for increasing the material needed for fusing the vertebrae. This type of graft is called an autograft. Harvesting a bone graft requires an additional incision during the operation. It lengthens surgery and can cause increased pain after the operation.

If you are having a decompression procedure, the surgeon may harvest your bone from the site of the decompression and use it as the graft. This type of graft is called a local autograft. The bone is essentially recycled; it is moved from where it is compressing your nerves to the area the surgeon wants to fuse.

One alternative to harvesting a bone graft is an allograft, which is cadaver bone. An allograft is typically acquired through a bone bank.

Today, several artificial bone graft materials have also been developed:

• Demineralized bone matrices (DBMs). Calcium is removed from cadaver bone to create DBMs. Without the mineral, the bone can be changed into a putty or gel-like consistency. DBMs are usually combined with other grafts, and may contain proteins that help in bone healing.


• Bone morphogenetic proteins (BMPs). These very powerful synthetic bone-forming proteins promote a solid fusion. They are approved by the U.S. Food and Drug Administration for use in the spine in certain situations.


• Autografts may not be needed when BMPs are used.


• Synthetic bone. Synthetic bone grafts are made from calcium/phosphate materials and are often called “ceramics.” They are similar in shape and consistency to autograft bone.

Your surgeon will discuss with you the type of bone graft material that will work best for your condition and procedure.

Immobilization

After bone grafting, the vertebrae need to be held together to help the fusion progress. Your surgeon may suggest that you wear a brace.

In many cases, surgeons will use plates, screws, and rods to help hold the spine still. This is called internal fixation, and may increase the rate of successful healing. With the added stability from internal fixation, most patients are able to move earlier after surgery.

Could There Be Complications?

Every surgery comes with some type of risk. These have been linked to this type of procedure:

• Bleeding


• Blood clots


• Infection


• Pain


• Risks from anesthesia


• Other potential problems include:


• Nerve injury: Numbness and tingling in a leg. You might lose movement, but that’s rare.


• Pseudoarthrosis: Sometimes the fusion doesn't work. After a few months, your back pain may return.


• Donor bone graft complications like infection or tissue rejection.

You can help prevent some of these issues by watching for the warning signs of infection. Tell your doctor right away if you have:

• A lot of swelling, redness or drainage by your wound


• Fever over 100 degrees F


• Increased pain


• Shaking chills

Recovery

Pain Management
After surgery, you will feel some pain. This is a natural part of the healing process. Your doctor and nurses will work to reduce your pain, which can help you recover from surgery faster.

Medications are often prescribed for short-term pain relief after surgery. Many types of medicines are available to help manage pain, including opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids.

Be aware that although opioids help relieve pain after surgery, they are a narcotic and can be addictive. Opioid dependency and overdose has become a critical public health issue in the U.S. It is important to use opioids only as directed by your doctor. As soon as your pain begins to improve, stop taking opioids. Talk to your doctor if your pain has not begun to improve within a few days of your surgery.