By Dr Swetha Pendyala
Consultant Neurosurgeon

Published on / 14 Nov 2022

Article Context

  1. Overview
  2. Procedure
  3. Benefits
  4. Risks
  5. Care at Medicover
  6. Frequently Asked Questions

Overview

Spinal fusion surgery is also called spondylodesis or spondylosyndesis. It is a surgical procedure in which two or more vertebrae are joined permanently into one solid bone with no space between them. The procedure aims to prevent the movement between two bones to avoid back pain or restore stability to the spine. It can be performed at any level in the spine (cervical, thoracic, or lumbar).

Spinal fusion is generally carried out with other spine surgical procedures. It may be combined with other surgical procedures for spinal stenosis, such as foraminotomy or laminectomy, or after a neck discectomy.


Spinal fusion is performed to treat:

  • Bone fractures or injury in the spine
  • Spondylolisthesis is a condition in which one vertebrae slips forward on top of another.
  • Weak spine caused by infections or tumors.
  • Abnormal curvatures such as in scoliosis or kyphosis.
  • Protruding or degenerated discs

Types of Spinal Fusion

  • 1. Anterior spinal fusion
  • 2. Posterior spinal fusion
  • 3. Vertebral interbody fusion

Procedure

Before the Procedure

  • The orthopedic or neurosurgeon will go over the details of the patient's medical history for the operation.
  • All the routine investigations, including blood tests, and X- rays such as CT and MRI, are done.
  • If you smoke, you should quit. Smokers who had spinal fusions may not heal well. You should also stop drinking alcohol.
  • Surgeon may ask to stop taking medicines such as blood thinners which make it harder for blood to clot.
  • If you have any heart problems, diabetes or other chronic medical issues, the surgeon will refer you to your regular doctor.
  • Patient should have all the physical parameters stable prior to the surgery as this is a major surgery.
  • Preoperatively, 8-hour fasting is required.
  • Prepare your house, such as raised toilet seats, shower chairs, slip-on shoes and other help will be required.

During the Procedure

  • The surgeon will typically begin a spinal fusion surgery by making an incision in a location that allows for the easiest and safest access to the affected vertebrae. This is usually done in one of 3 locations:
    • 1. The back or neck of your body, usually directly over the damaged portion of the spine.
    • 2. Throat or the abdomen above the affected part of the spine. This technique is also known as the Anterior approach. It allows the neurosurgeon to have better access to the front of the spine. It is typically a safer surgical approach because there is less risk of damaging the sensitive nerve roots that exit the spine.
    • 3. In rare instances, your neurosurgeon may choose a Transforaminal approach and access your spine from the side.
  • The purpose of spinal fusion is to prevent motion caused by segmental instability. This alleviates mechanical pain caused by excessive motion in the spinal segment.
  • The surgeon will then prepare the bone graft. Bone grafting is the transplantation of bone tissue to another part of the body to improve structural stability and promote bone growth around an implanted device.
  • This graft can be obtained from your pelvis or from a bone bank. A bone graft from a bone bank is provided by organ donors and stored in sterile conditions until it is required for operations such as spinal fusion.
  • The bone from the bone bank is subjected to rigorous testing, similar to blood transfusion. This is done to reduce the risk of the recipient contracting diseases such as AIDS or hepatitis. When a bone graft is placed between two or more vertebrae, the vertebrae grow together or fuse.
  • The spine surgeon will carefully place the bone graft between the affected vertebrae of the spine. The surrounding vertebrae will then be fitted with an interbody device, rods, or screws to reduce the movement and allow the bone graft to heal properly.
  • An epidural catheter (a thin, flexible tube) may be inserted into the back at the conclusion of the operation to help control pain.

After the Procedure

  • You may be in the hospital for 3 to 4 days after surgery.
  • In the hospital, you will be given pain medications orally or through an intravenous line (IV). You may have a pump that allows you to control the amount of pain medication you receive.
  • You will be instructed how to move properly, as well as how to sit, stand, and walk. When getting out of bed, you will be instructed to use the "log-rolling" technique. This means you move the entire body at once without twisting the spine.
  • You may be restricted from eating regular food for 2 to 3 days and will be given nutrients through IV and will eat softer food.
  • At the time of hospital discharge to go home, you may need to wear a back brace or cast.

Benefits

The benefits of back surgery are:

  • Increases fitness and mobility
  • Resumes normal activities
  • Increases productivity
  • Decreases back pain

Risks

Spinal fusion, like any surgery, has risks. Before the procedure, your doctor will discuss all the risks and specific precautions to avoid complications.

Potential risks of spinal fusion are:

  • Infection: Antibiotics are given regularly to the patient before, during, and often after surgery to reduce infections.
  • Bleeding: Bleeding is expected, but it is usually not significant.
  • Pain at graft site: Some patients may experience persistent pain at the site of the bone graft.
  • Pseudarthrosis: In this condition there is insufficient bone formation to form a solid fusion. Patients who smoke have a higher risk of developing pseudarthrosis. Diabetes and advanced age are the two other causes. Moving too soon before the fusion can also result in pseudarthrosis.
  • Recurring symptoms: Some patients may notice a return of their original symptoms.
  • Nerve damage: It is possible that nerves will be damaged during these procedures. These complications are very rare.
  • Blood clots: The formation of blood clots in the legs is another rare complication. These are extremely dangerous if they break off and travel to the lungs.

Care at Medicover

Medicover Hospitals offers advanced surgical and medical treatment to patients suffering from spine diseases and chronic pain. Hospital employs world class technology, cutting-edge techniques, and advanced therapies to help patients live pain-free lives. Medicover Hospital is recognized for its expertise & experience in the treatment of complex spinal conditions. We have the best spine surgeons and a dedicated team of staff who bring a wealth of experience and diverse expertise that has helped us grow into the best spine surgery hospital in India.

Frequently Asked Questions:

Once the surgeon confirms on X-ray imaging that the fusion has completely solidified into one bone, the patient can resume regular activities, including bending, lifting, and twisting. This approval usually comes about 6 months after the surgery, but it can take up to a year.

When awake, you must wear a brace for the first three months after surgery. You may remove the brace for short periods to shower or perform personal hygiene but remember to keep your back in a neutral position and avoid bending.

Electrical osteogenesis stimulators help to improve the bone healing process of the body. A procedure that is critical to the success of any type of spinal fusion surgery.

The spinal fusion procedure permanently fuses the targeted vertebrae of the spine and permanently eliminates painful motion at the affected segment. So, patients experience permanent mobility restrictions, such as an inability to twist, bend, and lift heavy objects.

Multilevel spinal fusion is a fusion of more than one spinal disc level (e.g., L3-L4 and L4-L5 fusions). When a multilevel spinal fusion is performed, it is almost always on contiguous spinal levels. The most common levels in multilevel spinal fusion are L4-5 and L5-S1.


References:

  • https://www.mountsinai.org/health-library/surgery/spinal-fusion
  • https://www.ucsfhealth.org/treatments/spinal-fusion-surgery-for-scoliosis
  • https://orthoinfo.aaos.org/en/treatment/spinal-fusion/
  • https://www.barrowneuro.org/treatment/spinal-fusion-surgery/