A fusion is the joining of two or more vertebrae into one solid bone.
The purpose of spinal fusion surgery is to stabilize the backbone in a certain area – usually the lower back or neck – or prevent excessive movement to avoid irritating nearby nerves. Barring emergency situations, spinal fusion surgery isn’t likely to be recommended until medication, physical therapy, and other conservative attempts at treatment have been tried for several months.
Why Might a Spinal Fusion Be Recommended?
A spinal fusion is often performed if removing a damaged or herniated disc will make the backbone unstable. In some cases, disc removal surgery (discectomy or microdiscectomy) is performed at the same time as a fusion surgery. The spine may also become unstable if vertebrae or facet (spinal) joints are severely damaged or deformed. Other possible reasons for fusion surgery include:
- Spinal instability caused by scoliosis and other abnormalities
- Weakness caused by degenerative conditions like arthritis
- Instability resulting from an injury
- Vertebral slippage (spondylolisthesis)
- Chronic back or neck pain that’s affecting quality of life and not responding well to other treatments
How Is the Procedure Performed?
Spinal fusion surgery typically involves an incision made to access the affected part of the spine and the placement of bone graft material in the area that will be “fused” together. This bone graft material can be synthetic (lab-created) or it may come from the patient’s own body (autograft). Some newer procedures are performed with biomedical materials used to create bone graft substitutes.
Since it will take time for bone graft material to turn into actual bone tissue, hardware that includes screws, rods, and metal plates is inserted to keep the spine stable. It usually takes several months for graft material to become solid. In the meantime, it’s important for patients to avoid placing excess strain and stress on the spine during the healing and recovery period.
Some fusion procedures are performed with robotic assistance to help with screw placement accuracy. Patients who are younger and otherwise healthy may be candidates for minimally invasive fusion procedures, some of which may be performed as outpatient procedures.
What Happens After Spinal Fusion Surgery?
Unless an outpatient procedure is performed, patients usually remain in a surgical center for a few days following spinal fusion surgery. Pain medication is usually prescribed to minimize discomfort as tissues heal, although such drugs are only meant to be used on a short-term basis to reduce addiction risks. This is why patients are encouraged to begin a personalized physical therapy program as soon as it’s safe to do so after fusion surgery. Post-procedure therapy may include:
- Exercises to strengthen spine-supporting muscles
- Flexibility and range of motion stretches and exercises
- Low-impact aerobic activities like walking
- Swimming and other water-based exercises and therapies
Spinal fusion procedures have advanced to the point where they are generally considered to be effective for patients who’ve been fully evaluated and prepared prior to surgery. The increased use of minimally invasive and innovative surgical techniques has also improved accuracy with hardware placement and reduced risks to nearby structures. Some fusion surgeries, like lateral lumbar interbody fusion (LLIF), can even be performed from the side to further minimize trauma to major back muscles.