The number of spinal fusion procedures performed worldwide has increased dramatically in recent decades, due in large part to advancements in techniques, spinal implants, bone grafting materials, and innovations in surgical approaches. In addition, it has also become an appropriate surgical option to treat a broader number of spinal conditions.
Spinal fusion surgery is a procedure in which two or more vertebrae are fused together to either realign them or eliminate movement between them. It corrects a spinal deformity (improper curvature), relieve pain caused by vertebrae that are rubbing together, and restore stability when vertebrae have slipped out of place.
Spinal fusion surgery was originally developed for, and continues to be used as, a treatment for spinal instability, deformities (such as scoliosis and kyphosis), and traumatic spine fractures. However, it is now also used to treat a wider range of issues, such as degenerative disc disease, spondylolisthesis, and spinal tumors.
When non-operative treatments fail to control back pain, neck pain, or potential neurological symptoms associated with degenerative processes in the spine, spinal fusion can be very effective in relieving symptoms by eliminating motion in the affected segment of the spine.
In spinal fusion surgery, surgeons place grafts (bone harvested from your own body, donor tissue or, sometimes, artificial bone ) that, over time cause the bone in two spinal vertebrae to grow into one another (fusion). Depending on which procedure is performed, they may use interbody devices (cages) that deliver bone materials and/or growth factors (artificially engineered versions of natural proteins that regulates bone healing) to the space between vertebra to generate fusion. Grafts can be placed in other locations as well, such as between the transverse processes of the vertebra or in the facet joints. Screws coupled to rods may be used to stabilize the vertebrae while new bone is growing.
Several minimally invasive techniques are available, for example endoscopic surgery. This technique involves visualization through an endoscope (a narrow tube) to access the spine to decompress and/or stabilize the spine. The advantage of this approach is to minimize muscle and soft tissue injury during surgery, usually also minimizing postoperative pain.
Before spinal fusion surgery, you may be screened with a test called a dual-energy x-ray absorptiometry (DEXA) or quantitative computed tomography scan (CT scan). This gives your doctors the ability to measure bone density within your vertebra. You may be given hormones and other medications for several months before or after your surgery to improve the strength of your bones and their ability to regrow.
Some patients – usually those having a minimally invasive spinal fusion – can return home on the same day as their surgery, but most will spend one or two nights in the hospital. Those with comorbidities (additional health problems, such as sleep apnea or a history of blood clots), who are having a complex fusion surgery or experience postsurgical complications may stay up to four or more nights.
Most people who have spinal fusion surgery are able to return to driving, about three weeks or more after surgery. You should consult your surgeon for their specific protocols.
This varies from individual to individual, however, patients are encouraged to start walking as soon as possible. In some cases, this is on the same day of surgery under the care and guidance of a physical therapist. Depending on your condition and/or need for walking aids prior to surgery, you may require a walking aid such as cane or walker for the first several weeks after surgery.
Recovery times depend on the type of procedure. In a study of patients who underwent either minimally invasive lumbar laminectomy (MI-L) or minimally invasive TLIF (MI-TLIF) surgeries, more than 90% of those in the first category and more than 85% of those in the second returned to work between two and four weeks. However, for some patients, full recovery can take up to six months. Your surgeon and physical therapist can advise on your particular case.
During the recovery period, you may be restricted from certain activities such as bending or twisting the low back and lifting more than 15 to 20 pounds at a time. Depending on your surgeon’s protocol, these restrictions may be gradually relaxed over the course of six weeks to several months. You will be encouraged to gradually increase your level of cardiovascular activity by walking, stationary cycling, or using an elliptical machine. When restrictions are lifted you can work on strengthening your core and doing other exercises to increase your range of motion.
After your recovery period is over and you have healed from spinal fusion surgery, there are no restrictions on your activities.
All surgical procedures carry some level of risk. There are a few main categories of risk when discussing spine surgery, including risk associated with anesthesia or risk of: infection, blood loss, damage to important anatomic structures (such as nerves, blood vessels, joints), or of developing additional spinal issues in the future. Because each individual has their own inherent risk profile and each surgery carries unique risks, it is best to discuss these topics with your surgeon directly.
Success after surgery can be measured in many ways. From a patient’s perspective, success might be relief of pain, improvement in neurologic function, and return to certain activities. Other measures of success include healing of the surgical wound, complete bony fusion, and degree of correction of a spinal deformity, among others. Because each scenario is unique it is best to discuss these topics with your surgeon directly.
Learn more from the articles below.
Learn about different types of fusion surgeries and about conditions that may be treated with spinal fusion.