Spinal Fusion

Definition

A spinal fusion is a surgery to weld together two vertebrae. Vertebrae are the bones that make up the spine.

Reasons for Procedure

To treat persistent pain and disability caused by:

Spinal stenosis (narrowing of the canal that the spinal cord runs through)
Spinal injury
Spondylolisthesis (vertebra is out of line with the others)
Scoliosis (abnormal curve in the spine)
Weak or unstable spine, usually due to infection or tumors
Herniated disk

Spinal fusion may be done if the treatments below do not relieve pain and disability:

Rest
Pain medicines
Muscle relaxants
Physical therapy
Injection of drugs to relieve pain and swelling
Massage
Bracing
Behavior change therapy

Imaging tests must also show a problem that can be fixed with this procedure.

Possible Complications

Complications are rare, but no procedure is completely risk-free. If you are planning to have a spinal fusion, your doctor will review a list of possible complications. These may include:

Bleeding
Infection
Incomplete fusion of the bones
Blood clots
Hematoma (build-up of blood in the wound)
Nerve damage causing pain, numbness, tingling, or paralysis
Impaired bowel and/or bladder function
Reaction to anesthesia

Factors that may increase the risk of complications include:

Smoking
Poor nutrition
Obesity
Advanced age
Preexisting medical condition

What to Expect

Prior to Procedure

Your doctor may do the following:

Physical exam, especially of the back and neck
X-ray—a test that uses radiation to take a picture of structures inside the body, especially bones
MRI—a test that uses magnetic waves to make pictures of the spinal nerves and disks between vertebrae
Myelogram—a type of x-ray that uses dye inserted near the spinal cord to show if there is pressure on the cord or the nerves
Possibly a CT scan—a type of x-ray that uses a computer to make pictures of the bones of the spine

Before your surgery:

Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
- Aspirin or other anti-inflammatory drugs
- Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)
Arrange for a ride home and for help at home.
Eat a light meal the night before. Avoid eating or drinking anything after midnight.

Anesthesia

General or spinal anesthesia may be used. With general anesthesia, you will be asleep. Spinal anesthesia will numb an area of your body, but you will be awake.

Description of Procedure

Your doctor will make an incision in your back or neck. The muscles will be spread to access the spine. Your doctor may fuse the bones with either:

Grafts made from pieces of bone or bony material (the pieces of bone may be taken from the pelvis [hip])
A small metal cage filled with bone graft material (the cage may be placed between the spinal bones)

Your doctor will implant screws and plates or rods to hold the bones in place while they fuse together. The incision will be closed with stitches or staples.

Lumbar Fusion

A metal cage filled with bone graft is placed between lumbar vertebrae.

How Long Will It Take?

4-6 hours (sometimes longer)

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. You will receive medicine after surgery to help manage pain.

Average Hospital Stay

3-4 days (sometimes less, sometimes more, depending on age, overall health, and extent of surgery)

Post-procedure Care

At the Hospital

You may receive the following care at the hospital:

Pain medicine
Back brace or cast
Lessons on how to properly move, sit, stand, and walk
Lessons on how to turn in bed without twisting the spine
Physical therapy
Special socks or boots to help prevent blood clots
You will be shown how to move and exercise your legs while in bed
You will be encouraged to get up and walk around several times a day

At Home

When you return home, do the following to help ensure a smooth recovery:

Be sure to follow your doctor's instructions.
Keep the incision area clean and dry.
Ask your doctor about when it is safe to shower, bathe, or soak in water.
Exercise your legs while in bed. This improves circulation and decreases the risk of blood clots.
Do not lift anything heavy.
The bones and grafts fuse together over several months. Your activity will be restricted during this time.
Only take medicine recommended by your doctor. Ask your doctor before taking any over-the-counter medicine.
Have the stitches or staples removed in two weeks.
Your doctor may tell you to permanently avoid heavy lifting and strenuous activities that involve lifting and twisting.

Rehabilitation

Rehabilitation may be done in a hospital or at an outpatient clinic. The program will likely include:

Exercises to strengthen your back
Low-impact aerobic exercises, such as walking or swimming

Time off from work ranges from 4-6 weeks to 4-6 months. It depends on your age, overall health, and the physical demands of your job.

Complete healing of the bones may take up to one year after surgery. You will likely notice less flexibility of your spine where the bones are fused. Following your rehabilitation program will speed your recovery and reduce discomfort.

Healed Lumbar Fusion

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:

Signs of infection, including fever and chills
Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or which persist for more than two days after discharge from the hospital
Pain that you cannot control with the medicines you have been given
Cough, shortness of breath, or chest pain
Joint pain, fatigue, stiffness, rash, or other new symptoms
Numbness, tingling, pain, or weakness, especially in the arms, hands, legs, or feet
Pain, swelling in your feet, legs, or calves
Loss of bladder or bowel function
Pain, burning, urgency, frequency of urination, or persistent blood in the urine

In case of an emergency, call for medical help right away.

RESOURCES

American Academy of Orthopaedic Surgeons http://www.aaos.org

American Association of Neurological Surgeons http://www.neurosurgerytoday.org

CANADIAN RESOURCES

Canadian Orthopaedic Association http://www.coa-aco.org

The University of British Columbia Department of Orthopaedics http://www.orthosurgery.ubc.ca

References

AAOS clinical guideline on low back pain/sciatica (acute) (phases I and II). American Academy of Orthopaedic Surgeons (AAOS) website. Available at: http://www.guidelines.gov/summary/summary.aspx?doc%5Fid=5369&nbr=003672&string=spinal+AND+fusion. Accessed September 9, 2005.

Deyo RA, Nachemson S, et al. Spinal-fusion surgery—the case for restraint. N Engl J Med. 2004;350(7):722-726.

Kim CW, Siemionow K, et al. The current state of minimally invasive spine surgery. J Bone Joint Surg Am. 2011 Mar 16;93(6):582-596.

Lindström D, Omid Sadr A, et al. Effects of a perioperative smoking cessation intervention on postoperative complications: a randomized trial. Ann Surg. 2008;248:739-745.

Lipson SJ. Spinal-fusion surgery—advances and concerns. N Engl J Med. 2004;350(7):643-644.

North American Spine Society. Phase III clinical guidelines for multidisciplinary spine care specialists. Spinal stenosis version 1.0. National Guideline Clearinghouse website. Available at: http://www.guidelines.gov/summary/summary.aspx?doc%5Fid=3609&nbr=002835&string=spinal+AND+fusion. Accessed September 7, 2005.

Spinal fusion. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00348. Updated September 2007. Accessed June 25, 2008.

Spinal fusion surgery. North American Spine Society website. Available at: http://www.spine.org/articles/spinalfusion.cfm. Accessed August 30, 2005.

Revision Information

Reviewer: Lawrence Frisch, MD, MPH
Update Date: 09/27/2011 -

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(Spinal Arthrodesis; Vertebral Interbody Fusion)