Spinal fusion

Answer 1

Definition

Spinal fusion is surgery to join together two bones (vertebrae) in the spine. Fusing permanently joins two bones together so there is no longer movement between them. Spinal fusion is usually done along with other surgical procedures of the spine.

Alternative Names

Vertebral interbody fusion; Posterior spinal fusion; Arthrodesis; Anterior spinal fusion; Spine surgery - spinal fusion

Description

You will be asleep and feel no pain (general anesthesia).

Your surgeon has several choices about where to make the incision (cut).

• The surgeon may make an incision on your back or neck over the spine. You will be lying face down on a special table. Muscles and tissue are separated to expose the spine.
• The surgeon may make a cut through one side of your belly (for surgery on your lower back). The surgeon will use tools called retractors to gently separate, hold the soft tissues and blood vessels apart, and have room to work.
• The surgeon may make the cut on the front of the neck, toward the side.

Other surgery, such as a diskectomy, laminectomy, or a foraminotomy, is almost always done first.

The surgeon will use a graft (such as bone) to hold (or fuse) the bones together permanently. There are several different ways of fusing vertebrae together:

• Strips of bone graft material may be placed over the back part of the spine.
• Bone graft material may be placed between the vertebrae.
• Special cages may be placed between the vertebrae. These cages are packed with bone graft material.

The surgeon may get the graft from different places:

• From another part of your body (usually around your pelvic bone). This is called an autograft. Your surgeon will make a small cut over your hip and remove some bone from the back of the rim of the pelvis.
• From a bone bank, called allograft.
• A synthetic bone substitute can also be used, but this is not common yet.

The vertebrae are often also fixed together with screws, plates, or cages. They are used to keep the vertebrae from moving until the bone grafts fully healed.

Surgery can take 3 to 4 hours.

Why the Procedure Is Performed

Spinal fusion may be recommended for persistent pain that does not get better with other treatments. It may be done in the following cases:

• Along with other surgical procedures for spinal stenosis, such as foraminotomy or laminectomy
• After diskectomy in the neck
• Injury or fractures to the bones in the spine
• Weak or unstable spine caused by infections or tumors
• Spondylolisthesis, a condition in which one vertebrae slips forward on top of another
• Abnormal curvatures, such as those from scoliosis or kyphosis

Risks

Risks for any surgery are:

• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Infection, including in the lungs (pneumonia), or bladder or kidney
• Blood loss
• Heart attack or stroke during surgery
• Reactions to medications

Risks for spine surgery are:

• Infection in the wound or vertebral bones
• Damage to a spinal nerve, causing weakness, pain, loss of sensation, problems with your bowels or bladder
• The spinal column above and below the fusion are more likely to cause other back later.

Before the Procedure

Always tell your doctor or nurse what drugs you are taking, even drugs or herbs you bought without a prescription.

During the days before the surgery:

• If you are a smoker, you need to stop. Patients who have spinal fusion and continue to smoke may not heal as well. Ask your doctor for help.
• Two weeks before surgery, your doctor or nurse may ask you to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and other drugs like these.
• If you have diabetes, heart disease, or other medical problems, your surgeon will ask you to see your regular doctor.
• Talk with your doctor if you have been drinking a lot of alcohol.
• Ask your doctor which drugs you should still take on the day of the surgery.
• Always let your doctor know about any cold, flu, fever, herpes breakout, or other illnesses you may have.

On the day of the surgery:

• You will usually be asked not to drink or eat anything for 6 to 12 hours before the procedure.
• Take your drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

You will need to stay in the hospital for 3 to 4 days after surgery. The repaired spine should be kept in the right 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 to 72 hours.

You will receive pain medicines in the hospital. You may have a pump where you control how much pain medicine you get, you may get shots or intravenous (IV) injections, or you may take pain pills.

You will be taught how to move properly 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, without twisting your spine.

You may not be able to eat for 2 to 3 days and will be fed through an IV. When you leave the hospital, you may need to wear a back brace or cast.

Outlook (Prognosis)

Spine surgery will often provide full or partial relief of symptoms.

Future spine problems are possible for all patients after spine surgery. After spinal fusion, the area that was fused together can no longer move. Therefore, the spinal column above and below the fusion are more likely to be stressed when the spine moves, and have problems later. Also, if you needed more than one kind of back surgery (such as laminectomy and spinal fusion), you may have more of a chance of future problems.

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 Engl J Med. 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.

Curlee PM. Other disorders of the spine. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 41.

Answer 2

Definition

Spinal fusion is surgery to join together two bones (vertebrae) in the spine. Fusion permanently joins two bones together so there is no longer movement between them. Spinal fusion is usually done along with other surgical procedures of the spine.

Alternative Names

Vertebral interbody fusion; Posterior spinal fusion; Arthrodesis; Anterior spinal fusion; Spine surgery - spinal fusion

Description

You will be asleep and feel no pain (general anesthesia).

The doctor will make a surgical cut to view the spine. This may be done:

• On your back or neck over the spine. You will be lying face down. Muscles and tissue are separated to expose the spine.
• On one side of your belly, if you are having surgery on your lower back. The surgeon will use tools called retractors to gently separate, hold the soft tissues and blood vessels apart, and have room to work.
• With a cut on the front of the neck, toward the side.

Other surgery, such as a diskectomy, laminectomy, or a foraminotomy, is almost always done first.

The surgeon will use a graft (such as bone) to hold (or fuse) the bones together permanently. There are several different ways of fusing vertebrae together:

• Strips of bone graft material may be placed over the back part of the spine.
• Bone graft material may be placed between the vertebrae.
• Special cages may be placed between the vertebrae. These cages are packed with bone graft material.

The surgeon may get the graft from different places:

• From another part of your body (usually around your pelvic bone). This is called an autograft. Your surgeon will make a small cut over your hip and remove some bone from the back of the rim of the pelvis.
• From a bone bank, called allograft.
• A synthetic bone substitute can also be used.

The vertebrae are often also fixed together with rods, screws, plates, or cages. They are used to keep the vertebrae from moving until the bone grafts fully healed.

Surgery can take 3 to 4 hours.

Why the Procedure Is Performed

Spinal fusion may be done in the following cases:

• Along with other surgical procedures for spinal stenosis, such as foraminotomy or laminectomy
• After diskectomy in the neck
• Injury or fractures to the bones in the spine
• Weak or unstable spine caused by infections or tumors
• Spondylolisthesis, a condition in which one vertebrae slips forward on top of another
• Abnormal curvatures, such as those from scoliosis or kyphosis

Spinal fusion may also be done along with other surgeries to treat spinal stenosis. These surgeries are done to make more room for your spinal nerve and column (such as foraminotomy or laminectomy). See: Spinal stenosis for more information

You and your doctor can decide when you need to have surgery.

Risks

Risks for any surgery are:

• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Infection, including in the lungs (pneumonia), or bladder or kidney
• Blood loss
• Heart attack or stroke during surgery
• Reactions to medications

Risks for spine surgery are:

• Infection in the wound or vertebral bones
• Damage to a spinal nerve, causing weakness, pain, loss of sensation, problems with your bowels or bladder
• The vertebrae above and below the fusion are more likely to wear away, leading to more problems later

Before the Procedure

Always tell your doctor or nurse what drugs you are taking, including medicines, herbs, and supplements you bought without a prescription.

During the days before the surgery:

• If you are a smoker, you need to stop. Patients who have spinal fusion and continue to smoke may not heal as well. Ask your doctor for help.
• Two weeks before surgery, your doctor or nurse may ask you to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and other drugs like these.
• If you have diabetes, heart disease, or other medical problems, your surgeon will ask you to see your regular doctor.
• Talk with your doctor if you have been drinking a lot of alcohol.
• Ask your doctor which drugs you should still take on the day of the surgery.
• Always let your doctor know about any cold, flu, fever, herpes breakout, or other illnesses you may have.

On the day of the surgery:

• You will usually be asked not to drink or eat anything for 6 to 12 hours before the procedure.
• Take your drugs your doctor told you to take with a small sip of water.

After the Procedure

You will stay in the hospital for 3 to 4 days after surgery.

You will receive pain medicines in the hospital. Pain medicine may be taken by mouth or given through a shot or a vein (intravenous line, or IV). You may have a pump that allows you to control how much pain medicine you get.

You will be taught how to move properly 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, without twisting your spine.

You may not be able to eat for 2 to 3 days. You will be given nutrients through an IV. When you leave the hospital, you may need to wear a back brace or cast.

Outlook (Prognosis)

People who had chronic back pain before their surgery are likely to still have some pain afterwards. Spinal fusion is unlikely to take away all the pain and other symptoms.

Even when using MRI scans or other tests, it is hard for your surgeon to always predict which patients will improve and how much relief surgery will provide.

Losing weight and getting exercise will increase the chance of feeling better

Future spine problems are possible for all patients after spine surgery. After spinal fusion, the area that was fused together can no longer move. Therefore, the spinal column above and below the fusion are more likely to be stressed when the spine moves, and may have problems later on.

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.

Brox JI, Nygaard OP, Holm I, Keller A, Ingebrigtsen T, Reikeras O. Four-year follow-up of surgical versus non-surgical therapy for chronic low back pain. Ann Rheum Dis. 2010 Sep;69(9):1643-8.

Curlee PM. Other disorders of the spine. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 41.

Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial. Spine (Phila Pa 1976). 2010 Jun 15;35(14):1329-38.

Matz PG, Holly LT, Groff MW, et al; Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons and Congress of Neurological Surgeons. Indications for anterior cervical decompression for the treatment of cervical degenerative radiculopathy. J Neurosurg Spine. 2009 Aug;11(2):174-82.

Reviewed By

Review Date: 06/04/2011

David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., and C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery.