Spinal fusion (arthrodesis) is a surgical procedure that joins, or fuses, two or more vertebrae. Spinal fusion is major surgery, usually lasting several hours. There are different methods of spinal fusion.

• Bone is taken from the pelvic bone or obtained from a bone bank. The bone is used to make a bridge between adjacent vertebrae. This bone graft stimulates the growth of new bone.
• Metal implants are secured to the vertebrae to hold them together until new bone grows between them.

Spinal fusion may be done by itself or in combination with decompression to treat painful symptoms caused by misalignment or instability of the vertebrae, such as spondylolisthesis.

Spinal fusion may also be done as a follow-up to decompression and debridement procedures done to treat spinal stenosis, herniated discs, spinal injuries, infection, tumors, and deformities.

Spinal Fusion Candidates

Your doctor may recommend spinal fusion if you have a broken vertebra, a spinal deformity, spinal weakness, spinal instability or chronic low back pain.

Spinal Fusion Outcome & Benifits

This surgery was originally developed as a way to stabilize the spine and treat deformity or fractures of the spine. Its use has now spread to treatment of degenerative bone or disc changes and spinal stenosis.

Spinal fusion is often necessary to stabilize the spine after a traumatic injury, infection, or tumor. There is no solid body of research supporting the effectiveness of spinal fusion for various other spinal conditions. One study showed no clear difference between spinal fusion surgery and intensive rehabilitation for treating chronic low back pain.2 In addition, the surgery is expensive and has significant risks. Therefore, although this type of surgery is common, it is controversial, and there is no guarantee of treatment success.

Prepare for Spinal Fusion

Preparation before surgery may involve trimming hair over the surgical site and cleaning the area with a special soap or antiseptic. Your doctor will give you specific instructions. Tell your doctor about any medications you are taking. You may be asked not to take some medications before the surgery.

Spinal Fusion Surgery Overview

Spinal fusion involves placing extra bone (bone graft) to fill the space between two spinal vertebrae. The bone graft material used in spinal fusion may be in a preformed shape, or it may be contained within a plastic, carbon fiber or metal cage. Your surgeon may use plates, screws or rods to hold the vertebrae and graft in place to promote healing after spinal fusion. Once the bone graft heals, the vertebrae are permanently connected.

Surgeons perform spinal fusion using general anesthesia, so you're unconscious during the procedure. The anesthesiologist or anesthetist gives you an anesthetic medication as a gas — to breathe through a mask — or injects a liquid medication into a vein.

The surgical team monitors your heart rate, blood pressure and blood oxygen throughout the procedure with a blood pressure cuff on your arm and heart-monitor leads attached to your chest. After you're unconscious, your surgeon will begin the procedure.

Surgeons have developed a variety of techniques for performing spinal fusion surgery. The technique your surgeon uses depends on the location of the vertebrae to be fused and the reason for spinal fusion. Generally, the procedure involves the following:

Bone Graft Preparation

The bone grafts that actually fuse two vertebrae together may come from a bone bank or from your own body, usually from a pelvic bone. If your own bone is used, the surgeon makes an incision above your pelvic bone, removes a small portion of it, and then closes the incision.

Incision

To gain access to the vertebrae being fused, the surgeon makes an incision in one of three locations: in your back directly over your spine; on either side of your spine; or in your abdomen, so your surgeon can access the spine from the front. The muscles and blood vessels then are moved away from the spine as much as possible to allow the surgeon to clearly see your spine.

Fusion

To fuse the vertebrae together permanently, the surgeon places the bone graft material between the vertebrae. Instruments such as small wire cages containing the bone graft material, as well as plates, screws or rods, may be put in place to help hold the vertebrae together while the bone graft heals.

Closure

The surgeon closes the incision using staples or stitches.

Minimally Invasive Technique

In selected cases, some surgeons use a minimally invasive technique to perform spinal fusion through several smaller incisions, rather than open surgery performed through one larger incision. Minimally invasive back surgery is complex and requires great skill. It's not available at all hospitals.

Spinal Fusion Recovery

After surgery, you're moved to a recovery room where the health care team watches for complications from the surgery and anesthesia. Your doctor may prescribe medication to relieve pain at the incision site.

A hospital stay of three to four days is usually required following spinal fusion. Depending on the location and extent of your surgery, you may experience some pain and discomfort after spinal fusion, but the pain can usually be well controlled with medications.

Depending on your age, general physical condition and desired activity level, time to full recovery from spinal fusion surgery can range from three to six months.

Spinal Fusion After Care

Following surgery, your fused spine needs to be kept in proper alignment. Your doctor may recommend you wear a brace for a time following surgery to keep your spine aligned correctly. Physical rehabilitation often is also part of recovery from spinal fusion. You'll learn how to move, sit, stand and walk in a manner that keeps your spine properly aligned. Rehabilitation may also involve back-strengthening exercises and a cardiovascular (aerobic) conditioning program. You may be able to start a physical rehabilitation program about four weeks after spinal fusion surgery.

When You Return Home

You can't return to your normal activities until your body has fused the vertebrae solidly in place. Healing after spinal fusion is similar to healing after a broken bone. Bone healing won't be apparent on X-rays until at least six weeks after spinal fusion.

Depending your medical condition and the the amount of lifting, walking and sitting your job involves, you may be able to return to work within four to six weeks for a sedentary job, or it may be as much as four to six months before you can return to a physically demanding job following spinal fusion.

Spinal Fusion Possible Risks

The risks associated with this procedure vary depending upon your age and overall health, diagnosis, and the type of procedure that is done.

Spinal fusion procedures frequently cause other problems.

Risks include:

• Pain at the bone graft site.
• Failure of the fusion process and/or breakage of metal implants.
• Deep venous blood clots that may also lead to pulmonary embolism.
• Nerve injury.
• Graft rejection.
• Superficial infection.
• Deep infection.