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Spinal fusion

Definition

Spinal fusion is surgery to correct problems in the spine bones (vertebrae). The surgery stabilizes the back by permanently placing certain bones in the spine together.

Fusing means two bones are permanently placed together so that movement between them can no longer occur.

Spinal fusion is usually done along with other surgical procedures of the spine, such as a diskectomy .

Alternative Names

Description

Spinal fusion surgery uses bone grafts, with or without screws, plates, cages, or other devices. The bone grafts are placed around the problem area of the spine during surgery. As the body heals itself, the graft helps join the bones together.

The most common spinal area treated is the lower (lumbar) spine. However, it can also be done on the upper (cervical) spine.

The procedure is performed while you are under general anesthesia (unconscious and pain-free). The surgeon makes a cut over the area of the spine that will be treated.

If you are having a problem in the lower spine corrected, the repair is done through a surgical cut made directly over the spine. This is called the posterior lumbar approach.

If you are having a problem in the upper spine corrected, the repair is usually done through a surgical cut in the front or side of the neck (anterior cervical spine).

If you are having a problem in the middle spine corrected, the repair is sometimes done through a surgical cut in the chest and abdomen (anterior thoracic spine).

Depending on the reason for surgery, the procedure may involve a combination of surgical cuts.

Why the Procedure is Performed

Spinal fusion may be recommended for:

• Abnormal curvatures, such as those seen with scoliosis or kyphosis
• Injury or fractures to the bones in the spine
• Herniated disk
• Spinal stenosis
• Weak or unstable spine caused by infections or tumors

If the pain is persistent and does not respond to other treatments, surgery is considered to relieve the pressure on the nerves.

Surgery is also performed for muscle weakness that does not improve or is getting worse, and for patients having bladder or bowel problems.

Risks

Risks for any anesthesia include the following:

• Reactions to medications
• Problems breathing

• Bleeding
• Infection

• Urinary difficulties (including urinary retention)
• Temporarily decreased or absent intestinal function (paralytic ileus)

Outlook (Prognosis)

While many patients have pain relief after surgery, the procedure is not always successful. Back pain sometimes returns, and more than half of patients develop sciatica.

Call your health care provider if persistent, severe back pain develops, especially if you have any numbness, loss of movement, weakness, or bowel or bladder changes.

Recovery

You will need to stay in the hospital for several days after surgery. The repaired spine should be kept in proper position to maintain alignment. If the surgery involved a surgical cut in the chest, a chest tube may be used to drain fluid build-up. The tube is usually removed after 24-72 hours.

You will be taught how to move properly, how to reposition, and how to sit, stand, and walk. You'll be told to use a "log-rolling" technique when getting out of bed. This means that you move your entire body at once, and not twist the spine.

There is usually considerable pain for the first few days after surgery. You will be given pain medication, perhaps by patient-controlled analgesia (PCA). You may also have a urinary catheter (tube) to collect your urine.

Because of the risk of temporary paralysis after spinal surgery, you may not be able to eat for 2-3 days and will be fed through an IV.

When you leave the hospital, you may need to wear a back brace or cast.

References

Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med. 2008;358:794-810.

Katz JN, Harris MB. Clinical practice. Lumbar spinal stenosis. N EnglJMed. 2008;358(8):818-825.

Chou R, Qaseem A, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478-491.

Hedequist DJ. Surgical treatment of congenital scoliosis. Orthop Clin North Am. 2007;38(4):497-509.

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