Spinal Fusion 101: Understanding Spinal Fusion Surgery

Back pain affects millions, but for some, relief remains elusive. Enter spinal fusion surgery. An estimated 40 percent of adults over 40 show signs of degenerative disc disease¹. Of these, 10 to 30 percent don’t respond to nonsurgical treatments. This creates a significant demand for effective procedures like spinal fusion. In fact, surgeons perform approximately 400,000 spinal fusions in the United States annually².

Spinal fusion surgery offers hope for many, but it’s not a guaranteed cure for all all symptoms associated with back arthritis. If you or someone you care about is struggling with persistent neck or back issues, understanding this surgical option could be crucial in your journey toward finding relief.

This article explores the essentials of spinal fusion surgery, covering everything from the procedure itself to the recovery process. By demystifying this common operation, you’ll feel empowered to make informed decisions about your spinal health and potential treatment options.

What is Spinal Fusion Surgery?

Spinal fusion is a surgical procedure that permanently connects two or more vertebrae. Vertebrae are the stacked bones that make up your spine. The vertebrae protect your spinal cord and have firm, jellylike discs that keep them separated from each other.

A variety of issues can occur within or around the vertebrae, causing them to move more than they should or develop arthritis. These include degenerative disc disease, injuries, or spondylolisthesis, which is the shifting of vertebrae. These conditions can lead to pinching of the nerves in your spine, pressure on your spinal cord, and muscle spasms. This excessive movement can cause pain. Spinal fusion surgery works to prevent the movement and thereby reduce or end pain, improve quality of life, and restore as much function in your spine as possible.

Types of Spinal Fusion Surgery

Spinal fusion surgery is not a one-size-fits-all solution. Surgeons have developed various approaches to address specific spinal issues and patient needs. Each technique targets different areas of the spine and offers unique benefits. Some of these techniques include:

• Cervical fusion: A spinal fusion in the neck (cervical spine)
• Anterior lumbar interbody fusion (ALIF): A spinal fusion performed from the front of the body
• Posterior lumbar interbody fusion (PLIF): A spinal fusion performed from the back of the body 
• Lateral lumbar interbody fusion (LLIF): A spinal fusion performed from the side
• Minimally invasive spinal fusion: A procedure using smaller incisions and specialized surgical tools
• Transforaminal Lumbar Interbody Fusion (TLIF): A spinal fusion that relieves chronic pain by treating two or more vertebrae in the lower back. It is performed slightly more from the side of the body.

Understanding these options can help you have more informed discussions with your health care provider about potential treatments. The right procedure for you will depend on the location of your condition and your doctor’s recommendations to address your symptoms safely and effectively.

Conditions Treated with Spinal Fusion Surgery

Spine surgery, particularly spinal fusion, can address a variety of conditions. It may be recommended for issues affected by:

1. Irregular movement or position of your vertebrae or discs
2. The shape or stability of the spine
3. Nerve irritation or compression due to spinal injuries or back arthritis

These factors can contribute to chronic pain or neurological symptoms that may benefit from the stabilizing effects of spinal fusion.

Your doctor may recommend spinal fusion if they determine your pain or movement difficulties stem from a spinal condition such as::

• Degenerative disc disease (spondylosis) or herniated disc(s)
• Spinal stenosis
• Scoliosis
• Spondylolisthesis (when a vertebra slips forward over the one below it)
• Pinched nerves
• Spine fractures
• Tumors in or around the spine
• Infections in and around the spine
• Congenital spine conditions (such as scoliosis or kyphosis)

A herniated disc—also called degenerative disc disease, a slipped disc or bulging disc—is one of the most common causes of neck, back, and leg pain. The disc between your vertebrae can cause various issues by pushing against the surrounding tissues and nerves, leading to pain. In some cases, these disc issues can improve with nonsurgical treatments like physical therapy, spinal epidural injections, pain medications, nonsteroidal anti-inflammatory drugs (NSAIDs), and rest. Unfortunately, around 10 percent of cases of disc issues do not resolve without surgical intervention³. 

Spinal stenosis is a condition in which your spinal canal narrows. This narrowing can lead to nerve compression, which causes significant pain. There are two main types of spinal stenosis: central canal stenosis (pressure on the spinal cord) and foraminal stenosis (compression of the spinal nerves). 

As with disc issues, nonsurgical treatments include physical therapy, spinal epidural injections, and pain medications. Surgery is generally the next step if those nonsurgical treatments fail to improve pain after three to six months⁴.

Is Spinal Fusion Surgery Right for Me

“One question I always ask a patient before I do surgery on them—the first thing I ask them before we even get started—is if you had to live the rest of your life like this, could you do it, living around your spine? If they say, yes, then they don’t get surgery,” says Leonel Hunt, M.D., an orthopedic spine surgeon for Commons Clinic.

Spinal fusion surgery is usually reserved for people who have tried, but have not had success with other treatments. A surgeon will best determine if you are a good candidate for this procedure. People who meet the following criteria may also be a good candidate for spinal fusion:

• Failed previous treatments: If other treatments or surgeries have not provided relief of your pain or impairments
• Fractures or trauma: If you have had spinal fractures or trauma that are causing serious instability of your spine
• Spinal deformities: The spine’s shape causes pain or impairment, such as in scoliosis or kyphosis.

Most importantly, your surgeon will evaluate whether you are healthy enough to recover well from spinal fusion. Spinal fusion is a complex and extensive procedure, and recovery depends on overall health, nutritional status, and lifestyle.

Preparing for Spinal Fusion Surgery

Being prepared for spinal fusion surgery is an important part of the surgical process. Always follow your surgical team’s directions carefully to ensure optimal outcomes. Preparation for spinal fusion varies with each person and depends on the type of procedure and your overall health.

Physical Preparation

To prepare for spinal fusion surgery, your doctor may order blood tests, imaging tests, and physical examinations by other specialists like an internal medicine or cardiovascular specialist. These examinations assess your overall health and the spine condition to evaluate whether you will be expected to recover well from the surgery. 

In addition to tests and examinations, discuss all of your medications with your surgeon, including any over-the-counter supplements, topical treatments, and herbal remedies you may be using. Some of these may interfere with things like blood clotting, wound healing, or other factors that can impact the success of your surgery and may need to be stopped prior to your surgery. 

Exercise to strengthen muscles and your cardiovascular system can be beneficial before surgery, under a licensed physical therapist’s supervision and with your surgeon’s permission. 

Nutrition also plays an integral role in preparation for your surgery. Eating a balanced diet high in protein, vitamins, and minerals can benefit wound healing and bone health. Seeking the help of a nutritionist can be helpful to develop a diet plan to maximize your nutrition before and after surgery. You may also consider seeing a weight loss specialist to help you lose weight before surgery, which can reduce the strain on your spine⁵. 

Lifestyle adjustments are also very important to consider. Smoking can increase your risk of infection and may interfere with bone healing. Don’t forget to prepare your home to accommodate any mobility needs post-surgery. Home preparations may include things like clearing halls and pathways of any tripping hazards, installing grab bars in the bathrooms, using nonslip mats in wet areas, purchasing tools to grab objects without bending, and placing essential items within easy reach. 

Mental Preparation

One of the most important ways to mentally prepare for spinal fusion surgery is to be informed and educated about the surgery, recovery timeline, and risks and benefits. Ask your care team any questions so you understand the procedure and postoperative care plan. Discuss pain management and follow-up care plans before surgery⁶.

Questions you may consider asking your care team include:

• What surgical technique will you use?
• How long will the procedure take?
• What are possible complications?
• What type of anesthesia will be used?
• What are typical outcomes for patients with my condition?
• What should I expect during recovery?
• What kind of physical therapy will I need?
• What are signs of complications?
• What is the follow-up schedule?
• When can I start doing activities?
• When can I start driving?

Another important part of mental preparation is your support system. Having people who can support you and provide assistance after surgery helps. Tell your care team if you need help after surgery, such as transportation home or immediate home care.

Perhaps the most important part of mental preparation is setting realistic expectations. Understand that spinal fusion surgery is complex and involves a gradual recovery process that can take weeks or months. Keeping this in mind will help you stay positive while focusing on recovery.

Preoperative Process

Additional preoperative steps may be taken, including:

• Anesthesia planning: Meet with an anesthesiologist before the procedure to discuss options. If you have had complications with anesthesia or have a history of PTSD, tell your anesthesiologist.
• Blood transfusion planning: Most people do not need a blood transfusion during a spinal fusion, but your surgeon may want to discuss a back-up plan.
• Cleansing: Your care team may provide washing and cleaning instructions for the day before or day of surgery.
• Eating and drinking: Your care team will discuss what you can or cannot eat or drink in the days and hours leading up to your surgery. 

On procedure day, you will check in and see the anesthesiologist, your surgeon, and surgical care team members who will ensure you have completed appropriate forms. They will also place an intravenous line (IV) into your vein for medications and fluids.

The Spinal Fusion Surgery Procedure

Spinal fusion surgery can be done through a traditional (open) approach or a minimally invasive approach, depending on the location and your surgeon’s recommendation. A traditional approach uses a larger incision, while a minimally invasive approach uses smaller incisions. If you have complex spinal issues such as severe misalignments, tumors, or need a more extensive fusion, you likely will need open surgery. Most spinal fusions take three to four hours.

During spinal fusion, you will receive general anesthesia to sleep through the procedure. The surgeon will make incisions to access the affected areas of the spine, then move aside the surrounding skin and muscle to expose the vertebrae and discs.

If the disc is affected, such as in degenerative disc disease, the surgeon removes it. The surgeon then fuses two or more vertebrae by placing bone graft or another material into the space where the disc was. If the disc is healthy, the surgeon may fuse the vertebrae together on the sides, leaving the disc in place.

Bone Grafting and Immobilization Techniques in Spinal Fusion

If using a bone graft, the surgeon will use bone pieces from another area of your body, from a donor, or from a bone bank. Alternatives to bone grafts, such as artificial bone graft materials, are also available. The surgeon chooses graft material based on a discussion with you, considering your preferences and medical recommendations. After bone grafting, surgeons often use plates, screws, and rods to stabilize the area.

Once the fusion is complete, the surgeon will close your incision with staples, sutures, or other closures. Some sutures need removal, while others dissolve. Your surgeon will tell you whether your sutures need removal and when to schedule follow-up care.

Risks and Complications of Spinal Fusion Surgery

Spinal fusion is a common and generally safe procedure, but like all medical interventions, it does come with some risks. Complications can range from wound irritation to more serious concerns like nerve damage, persistent pain, or infection. Understanding these potential risks is important for anyone considering this procedure.

Complications from spinal fusion surgery can happen for several reasons, including spine disease severity, overall health before surgery, individual response to surgery, surgeon skill and experience, hardware issues, not following postoperative care instructions, and skipping recommended rehabilitation and physical therapy. While not all complications are preventable, choosing an experienced, board-certified surgeon, following care and activity restrictions, and completing physical therapy can help.

Common problems after spinal fusion surgery include:

• Infection
• Bleeding
• Blood clots
• Issues with wound healing
• Injury to the blood vessels, nerves, and tissues around the spine
• Pain
• Anesthesia problems
• Paralysis
• Muscle weakness
• Reduced ability to move
• Failed fusion (failure of the bones to fuse as they should)
• Hardware issues (movement or malfunction of rods, screws, or plates)

Understanding potential risks and complications is crucial for making an informed treatment decision. While the procedure is generally safe and effective, discuss these possibilities with your health care provider. By weighing benefits against risks and following all preoperative and postoperative instructions, you can improve your chances for successful outcomes and smoother recovery.

Warning Signs To Look Out For 

Pay careful attention to your recovery and recognize any possible signs of a complication. If you notice any complications, contact your care team or head to an emergency room immediately. Early and prompt care is the key to preventing more severe complications. 

Warning signs of a problem after surgery may include:

• Swelling, redness, or pain in the lower leg. This can be a sign of a blood clot.
• Redness, swelling, or persistent drainage around the incision site. This can be a sign of infection. 
• Fever or chills. This can be a sign of infection. 

Recovery and Aftercare

Immediately after your surgery, you may be admitted to stay in the hospital for up to three or four days. Same day spine fusion surgery in an ambulatory surgical center may be appropriate for some patients.

In some cases, soft foods might be recommended for two to three days before a regular diet can be resumed as well. Soft foods can be easier to chew and swallow, reducing the strain on the body and help prevent complications like choking. They are also easier to digest, which can help a digestive system that is sensitive after surgery. 

Spinal fusion surgery recovery is a gradual process. Your surgeon will advise you on how soon after surgery you can resume many of your usual activities. Depending on your job and its physical demands, you may be able to return to work in a few weeks to months. 

The full results of your spinal fusion can take several months, although your comfort levels are likely to improve sooner than that. 

What to Expect in Terms of Pain Relief and Mobility

“I always tell people after you get spine surgery, you learn to live around your spine,” says Leonel Hunt, M.D., an orthopedic spine surgeon at Commons Clinic. “You adapt to the new spine you have.”

The road to recovery after spinal fusion surgery is gradual, with significant milestones. Understanding what to expect in the months after your procedure can help you set realistic expectations and stay motivated during rehabilitation.

• One to three months after spinal fusion: You may begin to see improved mobility and less pain. You may have lost some muscle strength and range of motion. A physical therapist can help you regain strength and safely increase your range of motion.
• Six months after spinal fusion: You can expect to see some final stages of healing. From six to 12 months after surgery, you may resume some normal activities, including some bending or twisting movements if your physical therapist and surgeon approve.

As you progress through recovery, remember that healing rates vary among people. Always follow your health care provider’s instructions and attend all follow-up appointments. With patience, dedication to rehabilitation, and proper care, you can work toward regaining strength, mobility, and a better quality of life after spinal fusion.

Pain Management

Pain is common after spinal fusion surgery and is part of healing. Your care team will work with you to ensure your comfort. Pain management includes medications like nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and acetaminophen that are usually prescribed short term for pain relief after surgery. Doctors sometimes prescribe steroids and muscle relaxants too. Remember that opioids, while effective against pain, can be addictive and should be taken only as directed by your doctor for short-term use.

Rehabilitation

The healing process after spinal fusion takes time. It can be several weeks or months before the fused bone becomes solid enough to withstand force. During healing, your care team will instruct you how to move and perform activities like walking or sitting to protect the fused spine’s alignment.

As you heal, you can gradually increase activities according to your surgeon’s and physical therapist’s recommendations. 

When to Start Physical Therapy After a Spinal Fusion

The time to start physical therapy after spinal fusion varies among patients, based on their surgeon’s recommendation. It typically starts at least six weeks after surgery, with some studies suggesting waiting 12 weeks⁷.

Physical therapy helps restore strength, function, and mobility after surgery. It can also help manage pain and reduce complications from immobility, such as blood clots or scar tissue formation.

During physical therapy, you will do:

• Strengthening exercises
• Stretching and range of motion exercises
• Aerobic exercises
• Posture and balance training
• Functional training (bending, reaching, lifting)

Long-Term Results and Prognosis

The healing process after spinal fusion is slow and gradual. In a small percentage of cases, pain may remain unchanged or worsen after surgery. This can happen if the procedure didn’t fully address the pain’s cause, if fusion causes scarring or changes that pressure nerves or tissues, or if spinal segments above or below the fusion degenerate. It’s difficult to predict who will improve significantly, even with imaging studies and thorough preoperative examination. Some restrictions after spinal fusion may be permanent.

If pain persists or worsens after spinal fusion, tell your care team. They can order diagnostic tests and examine you to assess the causes and find helpful solutions.

Advancements in Spine Surgery

Spine surgery continues to evolve and improve. Several ongoing clinical trials aim to advance minimally invasive techniques, discover regenerative treatments, improve pain treatment, and enhance postoperative recovery.

From artificial intelligence to robotic-guided surgery to bone graft options, spine surgery is a field where technological advances continue to improve outcomes for those with spine disease⁸. Artificial intelligence could help with surgical planning and guide surgeons during procedures. It also could help predict patient outcomes from spinal fusion. Robotic guidance could help surgeons improve precision and accuracy during surgery.

The future of spinal fusion likely will be influenced by advances in technology, new materials, and surgical techniques that aim to improve outcomes and extend life expectancy while reducing recovery time and complications. Spinal fusion may become less invasive and use robotics and endoscopy as well as new graft and disc replacement materials. Artificial intelligence may help predict surgical outcomes and plan complex procedures.

Frequently Asked Questions (FAQs)

When is spinal fusion necessary?

Spinal fusion may be recommended when other treatments fail to address the disease or pain, or you aren’t a candidate for other treatments. Like any surgery, spinal fusion has risks and benefits that you and your doctor must weigh based on your specific issues.

How long will I need pain medication after spinal fusion surgery?

Most people can stop taking pain medications within six to 12 weeks after surgery. Your doctor will help ensure your comfort by creating a safe and effective pain management plan. Talk to your surgeon about realistic expectations for post-surgery pain type and level.

When can I travel after spinal fusion surgery?

Travel timing depends on your recovery, your doctor’s and physical therapist’s recommendations, and your planned travel mode and length. Short car rides as a passenger may be permitted sooner, while long plane or car rides likely will be restricted for 10 months to a year after surgery.

How long does spinal fusion surgery take?

Spinal fusion surgery takes an average of three to four hours, but can range from one to seven hours, depending on your specific surgical plan. 

Conclusion

Spinal fusion remains a common option for people with chronic spine conditions that haven’t responded to other treatments. The procedure can reduce pain and improve quality of life by stabilizing the spine. It’s important to understand that spinal fusion is a serious surgery with a slow recovery and risk of future spine-related issues.

At Commons Clinic, our experienced team of spine specialists can guide you through every step of the spinal fusion process. From initial consultations to post-operative care, we’re committed to providing personalized treatment plans and comprehensive support to optimize your outcomes.

As new technologies continue to develop, the future of spinal surgery looks promising. Innovations that include more personalized and less invasive procedures will potentially improve outcomes and reduce recovery times. 

If you are considering spinal fusion surgery, work closely with your surgeon and healthcare team to ensure you are optimally prepared for the procedure and have realistic expectations of the recovery process and long-term results.

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