• Spinal Fusion

    (Spinal Arthrodesis; Vertebral Interbody 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 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
    Spinal fusion lumbar
    A metal cage filled with bone graft is placed between lumbar vertebrae.
    Copyright © Nucleus Medical Media, Inc.

    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
    Nucleus Image
    Copyright © Nucleus Medical Media, Inc.

    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.

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