Spinal fusion is a surgical technique used to combine two or more vertebrae. This spine procedure is used primarily to eliminate the pain caused by abnormal motion of the vertebrae by immobilizing the vertebrae themselves.
Spinal fusion is done most commonly in the lumbar (lower back) region of the spine, but it is also used to treat cervical and thoracic problems. Patients requiring spinal fusion have either neurological deficits or severe pain which has not responded to conservative treatment. Conditions requiring spinal fusion may be include: -degenerative disc disease -discogenic pain - spinal tumor -vertebral fracture -scoliosis -kyphosis -spondylolisthesis -spondylosis -other degenerative spinal conditions any condition that causes instability of the spine
-By fusing the level, there is less concern that the patient will need surgery again at that level. If the discs and/or facets are pain generators, as is often the case, a fusion will ensure that motion at the level is stopped, potentially eliminating the low back pain.
-It reduces post-decompressive deformity. Some patients develop post-laminectomy kyphosis, which is an abnormal alignment of the spine. This too can often lead to additional surgery. Similarly, a fusion can correct any deformity the patient had before surgery and ensure that the normal alignment of the spine is restored. This may reduce wear and tear (and need for future surgery) on the neighboring levels.
-Spinal fusion involves extensive bone work, which can lead to more back pain and longer recovery. The lateral facet joints and transverse processes (specific parts of your vertebra, both located on the sides of each vertebra) are typically exposed during a fusion. This necessitates more muscle dissection.
-Bone graft or bone substitutes are also placed in the spine to help your bones gradually fuse together, but inflammation can result and potentially lead to more scarring (arachnoiditis) and subsequent pain.
-Most fusions involve placing rods and screws that aim to stabilize the spine until the bony fusion grows solid. There is a slight risk of this hardware causing nerve irritation and perhaps new or residual leg pain/weakness.
-A fused segment ("segment" refers to two vertebrae and the disc in between them) may cause more stress on the level above and below the fusion.
In most cases, the fusion is augmented by a process called fixation, meaning the placement of metallic screws (pedicle screws often made from titanium), rods or plates, or cages to stabilize the vertebra to facilitate bone fusion. The fusion process typically takes 6-12 months after surgery. During this time external bracing (orthotics) may be required. External factors such as smoking, osteoporosis, certain medications, and heavy activity can prolong or even prevent the fusion process. If fusion does not occur, patients may require re-operation.
Some medications need to be continued or stopped the day of surgery. Medications that thin the blood should be stopped 7-10 days prior to surgery. Do not drink alcohol 1 week before and 2 weeks after surgery to avoid bleeding problems. The most important way to achieve a successful spinal fusion surgery is to quit smoking. Stop all tobacco use: cigarettes, e-cigarettes, cigars, pipes, chewing tobacco, and smokeless tobacco (snuff, dip). Nicotine prevents bone growth and decreases successful fusion. Many patients have trouble with constipation after surgery caused by pain medication and anesthesia. The week before surgery eat foods high in fiber including fruits, vegetables, beans and whole-grain cereals and breads. Drink water; 8 to 10 glasses of fluid every day. Walking also helps the intestines move more rapidly and regularly.
After the surgery some may experience back pain and will have to use a brace. Surgery in adults tends to be lengthier and also recovery seems to be longer than in children.
Injury to the spinal cord is rare, resulting in less than one per cent of all cases. However, as with any spine surgery, there are risks, including the possibility of:
Bleeding occurring after surgery
Infection requiring antibiotics
Instrumentation problems- loosening of instruments after surgery
What Is the success rate of spinal fusion surgery?
Up to 80 percent of all spinal fusion surgery patients report satisfaction with the success of the procedure. Studies of post-operative patients indicated that patients enjoyed, on average, a 60 to 70 percent reduction in their symptoms.
What does recover look like after spinal fusion?
Full recovery from a spinal fusion surgery may take up to a year. Generally, however, you should be able to return to your everyday routine within 4 to 6 months. You'll spend the first few days of recovery in the hospital. After 4 to 6 weeks, your Torrance spine surgeon will put you on a physical therapy routine to optimize your remaining recovery time, and to help ensure that you regain strength, comfort, and function.
Do I need to wear a brace after my surgery?
Most doctors want their patients to wear a back brace after spinal fusion surgery. A brace may be needed due to the number of levels fused; the procedure performed; the patient’s age; the condition of the patient’s bone; and other health problems such as diabetes, smoking and obesity.