Spine surgery

Spinal fusion

This article provides general information about spinal fusion surgery and is not a substitute for advice from Dr Reddy. It does not account for your individual health, diagnosis or treatment plan.

 

Spinal fusion surgery fixates and fuses two or more bones in the spine (vertebrae) together to stabilise or realign the spine. This also helps to prevent the surrounding nerves, ligaments and muscles from being stretched and reduces pain.

Many people only need fusion of two vertebrae, but some people may need fusion of more than this. Spine fusion can make the affected area less flexible but the improvement in pain and function is of greater benefit.

Sometimes, spinal fusion surgery is done with another neurosurgical procedure, such as a laminectomy (decompression) – surgery that eases pressure on the spinal nerves or cord –  or discectomy – surgery that treats a herniated or damaged spinal disc.

Why might someone need a spinal fusion?

A neurosurgeon may recommend spinal fusion surgery to a person with any of the following conditions:

  • degenerative disc disease
  • arthritis
  • spinal stenosis
  • spondylolisthesis
  • scoliosis
  • spinal fractures
  • spinal infections
  • spinal tumours

However, surgery is usually a last resort to fix spinal problems so Dr Reddy may first advise to wait and see if your symptoms resolve on their own or to try nonsurgical treatments. If these options are not appropriate or are unsuccessful, a spinal fusion may be recommended.

How is spinal fusion done?

A spinal fusion surgery can be performed the traditional way or as a minimally invasive procedure, which involves a smaller incision (a surgical cut) to the skin to reach the spine. The surgeon may access the spine from the front, back or side of the body. The approach will depend on your condition and anatomy.

Once the person has been anaesthetised, the surgeon makes an incision then uses surgical instruments to move the muscles aside to expose the spine. To achieve fusion, the affected vertebrae will be fixated with titanium screws , rods, metal plates, and/or cages/spacers. Then the surgeon will place a bone graft, which may come from the body of the person (usually the pelvis) or from a bone donor, or a synthetic bone substitute.

To finish, they will close the incision with sutures and a dressing will be placed over the wound. In some cases, a device may drain excess fluid from the wound for a day after surgery.

After the operation, the vertebrae gradually fuses into a single, strong bone that provides stability.

What are some different types of spinal fusion?

An anterior cervical discectomy and fusion involves removing a herniated or damaged spinal disc in the neck and replacing it with an implant or bone graft, also called a cage or spacer. The graft helps to fuse the vertebrae above and below it. The surgeon reaches the affected area from the front of the neck because it is more accessible than from the back where the spinal cord, nerves and strongest neck muscles are.

A lumbar interbody fusion involves replacing a spinal disc in the lower back with a graft or implant made of bone, metal or plastic, called a cage or spacer, and fusing the vertebrae either side together. This type of fusion can be performed in different ways:

  • posterior lumbar interbody fusion – the spine is reached from the back
  • transforaminal lumbar interbody fusion – the spine is reached from one side, via the back
    anterior lumbar interbody fusion – the spine is reached from the front (abdomen)
  • lateral lumbar interbody fusion (also called extreme lateral interbody fusion or direct lateral interbody fusion) – the spine is reached from the side of the waist

What are the benefits of spinal fusion?

Many people who follow the advice to prepare for and recover from their operation will feel less pain afterwards. However, even if surgery is successful, it is important to remember that you may experience back pain in the future since the spine gradually keeps changing over time. This means some people may need to have another fusion in the future.

It is important to maintain a healthy lifestyle to get the most out of your surgery, including by exercising regularly, keeping a healthy weight and not smoking.

What are the risks of spinal fusion surgery?

Spinal fusion surgery is very safe but all surgical procedures carry risk.

Factors such as age, smoking and significant medical problems, such as obesity and diabetes, can increase the risk of complications occurring.

General risks of surgery

The following are general risks of surgery.

  • bleeding a lot (this sometimes requires a blood transfusion)
  • lung or urinary tract infections
  • cardiovascular problems such as heart attack, stroke or blood clots that travel to the lungs (this is a medical emergency and must be treated quickly)
  • keloid or hypertrophic scarring (red, raised scars, which are not a health risk)

Risks of a spinal fusion

The following are risks of spinal fusion surgery:

  • pain and symptoms persist, even though surgery is a success
  • infection of the wound, vertebrae, or space around the spinal cord or spinal nerves
  • spinal nerve injury that causes pain, weakness, numbness or less sensation
  • cauda equina syndrome (injury to nerves that control the bladder and bowel) – this causes loss of bladder and bowel control and is an emergency, though treatment is effective
  • spinal cord injury – this can cause paralysis from below the area where surgery was done
  • dural tear (a hole in the lining covering the spinal cord) – this leads to spinal fluid leaking
  • spinal hardware loosening or breaking over time
  • injury to a major blood vessel needing urgent repair
  • pseudarthrosis (spine doesn’t fuse)

If any of these occur, the surgeon may change their surgical plan and the person may need more surgery.

Depending on the type of spinal fusion a person has, the following can also happen:

  • difficulty swallowing
  • injury to the oesophagus or trachea
  • injury to the recurrent laryngeal nerve, which can make a person’s voice hoarse
  • injury to the specific sympathetic nerves, which may make an arm or a leg swell and feel hot
  • thigh pain, numbness, less sensation or weakness – this usually gets better over 6 weeks
  • vertebral artery damage, which may cause stroke
  • retrograde ejaculation (semen entering the bladder instead of going through the penis when orgasming)

How should I decide to have spinal fusion surgery?

The decision to have spinal fusion surgery should be made after discussing your medical condition and the benefits, risks and limitations of this surgery with Dr Reddy.

If you decide to have surgery, you will need to sign a consent form. Please read this carefully before signing it. If you have any questions, ask Dr Reddy.

How should I prepare for a spinal fusion?

It’s important to tell Dr Reddy about any medication you are taking since some medicines, including ibuprofen (aspirin) and other anti-inflammatory drugs, may be unsafe to have before surgery.

You may need to stop eating and drinking for several hours beforehand.

Make sure you take any items that you’ll need for an overnight stay at hospital, and organise for someone to pick you up since you won’t be allowed to drive after the procedure.

What happens after surgery?

After surgery, you’ll be taken to the recovery room where your health will be monitored until you are fully awake. You’ll then be taken to the regular ward and given medication to help control any pain around your incision.

Most people can start moving and walking while they’re still in hospital. This is important to prevent blood clots.

Many people may go home after 5 to 7 days. Dr Reddy may recommend wearing a brace and doing physical therapy to keep your spine properly aligned.

Older patients may benefit from a short period of recovery in a rehabilitation hospital to improve their mobility and confidence.

 

Please only refer to this information in consultation with Dr Reddy. If you have any questions, ask Dr Reddy.

 

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