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Spinal Fusion
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Spinal Fusion

(Spinal Arthrodesis; Vertebral Interbody Fusion)

En Español (Spanish Version)

Definition

A surgical procedure to weld together vertebrae (bones of the spine)

Parts of the Body Involved

  • The spine, typically in the neck or lower back
  • Tissue surrounding the spine
  • Bone from the hip or pelvis (if used for bone grafts)

Reasons for Procedure

To treat persistent pain and disability caused by:

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

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

Also, imaging tests must show a structural problem that can be fixed by fusing bones together.

Risk Factors for Complications During the Procedure

  • Smoking
  • Poor nutrition
  • Obesity
  • Advanced age
  • Pre-existing medical condition
  • General ill health

What to Expect

Prior to Procedure

Your doctor will likely do the following:

  • Physical exam, especially of the back and neck
  • X-rays —a test that uses radiation to take a picture of structures inside the body, especially bones
  • MRI scan—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

Anesthesia

General or spinal anesthesia

Description of the Procedure

The surgeon makes an incision in the back or neck and spreads the muscles to access the spine. Pieces of bone or bony material (called grafts) are placed between vertebrae. The pieces of bone may be taken from the hip or pelvis. Or a small metal cage filled with bone graft material may be placed between the vertebrae. The surgeon will implant screws and plates or rods to hold the bones in place while they fuse together. The incision is closed with stitches or staples.

Lumbar Fusion

Spinal fusion lumbar

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

© 2008 Nucleus Medical Art, Inc.

After Procedure

The following may be inserted after the surgery:

  • Catheter to drain your bladder
  • Chest tube to drain fluid build-up
  • Tube into your nose and down your throat to your stomach

How Long Will It Take?

4-6 hours (sometimes longer)

Will It Hurt?

Anesthesia prevents pain during the surgery. You will receive pain medication after surgery.

Possible Complications

  • 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

Average Hospital Stay

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

Postoperative Care

At the Hospital

You may receive the following care at the hospital:

  • Pain medication
  • 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

While in the hospital, you may be asked to:

  • Move and exercise your legs while in bed
  • Get up and walk around several times a day

At Home

Follow your rehabilitation program as instructed. Keep the incision area clean and dry. Take only medications recommended by your doctor. Do not take other remedies without your doctor's approval. Do not lift anything heavy.

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

Outcome

The bones and grafts fuse together over several months. During this time, your activity will be restricted. Time off from work ranges from 4-6 weeks to 4-6 months. Time off will depend on age, overall health, and the physical demands of the job. Complete healing of the bones may take up to a year after surgery. Your doctor may tell you to permanently avoid heavy lifting and strenuous activities that involve lifting and twisting. 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

© 2008 Nucleus Medical Art, Inc.

Call 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
  • Cough , severe nausea, or vomiting
  • Pain, burning, urgency, frequency of urination, or persistent blood in the urine
  • Pain and/or swelling in your feet, calves, or legs
  • Sudden shortness of breath or chest pain
  • Weakness or paralysis that was not present in the hospital after surgery
  • Loss of bowel or bladder function
  • Numbness, tingling, pain, or weakness, especially in the arms, hands, legs, or feet

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/index.html/

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_id=5369&nbr=003672&string=spinal+AND+fusion . Accessed September 9, 2005.

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

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_id=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/fact/thr_report.cfm?Thread_ID=156&topcategory=Spine . 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.



Last reviewed November 2007 by Rosalyn Carson-DeWitt, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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