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Spinal Fusion
What is Spinal Fusion?
Back pain can be the result of many different problems. One cause can be hyper mobility between the vertebrae - the bones that make up the spine. This increased mobility can cause pain and functional problems. There are various ways to treat this condition, both conservative and surgical. While surgery is generally the last resort, spinal fusion is often the chosen method of treatment. Spinal fusion is a surgical method of correcting back or neck pain that is caused by these hyper mobile vertebrae. The surgery involves fusing or connecting two or more vertebrae together permanently.
How is the procedure done?
Spinal fusion is performed under general anesthesia. The spine is either approached from the front (anterior – as in most cervical fusion) or from the back (posterior – generally the method used for thoracic and lumber fusion.) No matter what direction the spine is accessed, the fusion involves inserting a bone graft between the vertebrae where the excess motion is located. Then the vertebrae are stabilized using screws and plates. The hardware helps to correct any deformity that may exist in the spine and it also acts as a splint that allows the bone graft to fully heal following surgery.
The bone that is used in the graft can either be harvested from another part of the body or can be attained through a bone bank. A graft that is done using the patient’s own bone (autograft) has the fastest healing rate and is most successful. However, occasionally bone from another donor (allograft) is necessary due to other health reasons. Since another incision is not needed to harvest the bone, patients receiving an allograft report having less post-surgical pain.
Why is it needed and how do you know if you need it?
Spinal fusion may be required for a number of conditions. One of the most common reasons is if the spine experiences trauma resulting in a fracture to one of the vertebrae. Occasionally the fracture can cause injury or impingement of the spinal cord. Surgery enables the doctor to prevent further pain and damage by stabilizing the vertebrae and removing any bone fragments that remain.
Another reason that spinal fusion is considered as an option is if there is some deformity in part of the spine. One of the most common deformities that is often corrected with spinal fusion is scoliosis. Scoliosis causes the naturally occurring curves of the spine to be skewed. Fusing two or more of the vertebrae together helps to restore the proper curve the spine needs.
The third most common condition that may require spinal fusion to correct is spondylolisthesis, the slipping forward of one vertebrae on top of another. Fusing the vertebrae together prevents this slippage and eliminates the problem.
Occasionally a herniated disc may also require fusion to stabilize the joint. Once the herniated disc has been removed, spinal fusion is required to ensure the joint doesn’t become too mobile.
In order to determine the necessity of spinal fusion, most doctors prescribe other non-surgical treatments before considering surgery. Often, physical therapy, drug therapy, or treatment by a chiropractor can eliminate spinal pain, eliminating the need for surgical intervention. A doctor may also order tests like diskogram to determine what part of the spine is causing the pain. This allows the doctor to pinpoint the origin of the pain, allowing the surgery to be more successful.
What is the recovery time?
The recovery time for spinal fusion can vary from several weeks, up to several months. Recovery depends on many factors including age, activity level, and over health condition.
What activities cannot/should not be done after spinal fusion and what are the long term results?
Following spinal fusion surgery, there are a few limitations on the activities that can be done until the fusion is fully healed. Total sitting time needs to be limited to approximately twenty minutes at a time. Activities that require twisting and bending also need to be avoided, as well as car trips longer than twenty minutes.
While spinal fusion often reduces the pain it rarely totally eliminates it. Since the newly fused joint has to bear an increased amount of stress following surgery, there can be significant wear and tear damage over time. Approximately 20% of people that undergo spinal fusion need to have another surgery within ten years.