What is a spinal fusion?
The purpose of a spinal fusion is to surgically attach two or more vertebral bodies in an effort to correct a specific spinal problem. During the process of spinal fusion, the combinations of rods and screws, bone graft and other structural implants are used to improve the patient’s specific complaint. Anatomic locations of spinal surgery are cervical spine/neck, thoracic spine/upper back and lumbar spine/low back.
Why it's done
Conditions that affect the spine that may require spinal fusion can be numerous and rather diverse. Spinal fusion can be used to treat:
Painful arthritis/degenerative disc disease
This disease can be viewed as the progression of arthritis, biologic wear and tear and or even a genetic consequence. This adversely affects the normal disc functioning, such as a cushion and mediator of spinal motion. As the disc space gradually wears down and bulges into the spinal canal, spinal stenosis (which is narrowing of the spinal canal) gradually ensues. This usually produces pain and can even produce neurologic signs and symptoms, such as sciatica or difficulty walking due to leg weakness (known as neurogenic claudication).
This condition usually occurs in patients in their 60s or older. It can also occur in younger patients from either trauma or congenital/heredity reasons. The vertebral body slides forward in relation to the one below it. This classically presents with low back pain and associated sciatica or leg pain while walking and standing. This can be so severe that the patient is forced to sit down or lean forward to help relieve pain and discomfort. (Patients will commonly state they lean forward on a shopping cart while shopping.) Spinal fusion can also treat spinal instability from other causes such as trauma, fracture and deformity such as scoliosis.
When the disc herniates into the spinal canal and compresses a nerve, it usually produces the classic symptom of pinched nerve and resulting numbness and tingling (sciatica) or even muscle weakness. In the cervical spine or neck, these are routinely treated with a cervical fusion known as an anterior cervical discectomy and fusion (ACDF).
Complications of spinal fusion surgery can vary tremendously from patient to patient, depending upon underlying past medical history and surgical history. Three commonly discussed issues include blood loss, nerve damage and infection. For spinal fusion procedures, blood loss is routinely less than the amount donated while donating blood at a blood drive. The need for blood transfusions in spinal fusion surgery is very rare in the United States. Nerve damage is also a rare event during spinal fusion surgery and is minimized with computer technology known as neuro-monitoring. Post-operative Infections are also a rare event and seem to be related to correctable or improvable risk factors such diabetes, obesity, smoking history, duration of surgery and prior surgical site infections. Specific complications need to be discussed with your surgeon prior to consenting and proceeding with a spinal fusion.
Types of spinal fusion
Recovering from spinal fusion surgery comes in a few distinct phases and varies depending upon the type and extent of the procedure. For example, a one level cervical/neck fusion (ACDF) can easily and routinely be performed as an outpatient surgical procedure (meaning the patient can go home the very same day), whereas a large deformity/scoliosis operation may require multiple days in the hospital.
- Pain is managed with combinations of medications.
- Bracing such as a cervical collar or a lumbar sacral orthsis (LSO) or even a thoracic brace (TLSO) may be utilized at the surgeon’s discretion. Bracing may improve a patient’s post-operative pain and add stability to the spine.
- Physical therapy is initiated the first day after surgery. This is directed at preparing the patient for a safe discharge home with proper functioning. In some cases, rehabilitation centers are required to maximize recovery prior to the patient coming home.
- Follow-up visits with your surgeon are routine. Monitoring the patient’s progress with skin incision/surgical site and neurologic examinations is critical. Weakness or signs and symptoms of infection, such as fever and redness at the surgical site, need to be reported to your physician immediately.