Spinal Fusion Surgery is used to repair a severely degenerated segment of the spine when Disc Replacement surgery is not available.
The term “Fusion” means healing with bone. When you break a leg bone, it heals by fusing. When the spine fuses, it heals with bone as well. Bone needs stability to heal or ‘fuse.’ This is why we put a broken leg in a cast or a metal rod down the middle of the bone. Spine bones need stability to grow bone and fuse as well. In the old days, patients were left in bed for months or actually put in back casts! Now, with modern technology, we are able to put bracing on the inside with surgery and have patients wear removable braces on the outside to promote bone healing and spine fusion.
When is Spinal Fusion Surgery Needed?
If there is instability or deformity in the spine, spinal fusion surgery may be needed.
What is deformity of the spine?
Deformity of the spine caused may be caused by scoliosis or other conditions.
The abnormal curvature is corrected and held in place by titanium rods until the spine grows bone and fuses in this position. Occasionally these rods are removed, but only if they are causing discomfort.
Arthritis: when the joints of the spine wear out from arthritis, they can become incompetent and cause slipping of the spine. The body tries to heal this arthritis by growing more bone in an attempt to fuse itself. These spurs can crowd the nerves and cause nerve pain.
Spondylolisthesis is the term used for slipping of the spine. When we remove the bone spurs from the pinched nerves, we have to put bracing in to support the spine so the spine can fuse in that position. The spine tries to heal itself by growing bone!
This is the same type of arthritis that affects the hips or the knees causing total joint replacement.
Unfortunately, we do not have spine replacement surgery!
Motion preservation is always the goal of spine care whenever possible.
Disc Replacement (ADR) is a less invasive alternative that removes the damaged disc and replaces it with an artificial implant designed to mimic the function of a healthy disc. This disc replacement surgery preserves the motion of the spine while treating pain and lowering the risks future adjacent level degeneration.
Is It Possible for Spinal Fusion Surgery to Fail?
Some will say “Spinal fusion surgery has a high overall success rate”. With modern technology, there is a very high rate of successful fusion of the vertebrae, although success at resolving chronic pain issues is limited.
There are also factors that can delay fusion or result in a non union, age, smoking, diabetes, and obesity are the top culprits.
What are the Possible Complications of Spinal Fusion Surgery?
Complications of spinal fusion surgery are not rare. They are higher in patients who smoke, have diabetes or are obese. If it is determined that a patient has a delayed union, a bone stimulator machine is often ordered to promote healing.
What is adjacent segment disease related to spinal fusion surgery?
Adjacent segment disease (ASD) after a spinal fusion surgery is likely.
Fusion surgery patients have approximately a 4% per year risk of developing degeneration at an adjacent level. This is thought to occur in part due to the increased stress on those segments from the loss of motion at the fused joint. Treatment may become necessary to address the new level issues.
Will spinal fusion surgery resolve chronic pain?
Spinal fusion surgery is often recommended to treat chronic pain conditions, However, it is possible for chronic pain to fail to improve or even get worse, or for new pain to develop after spinal fusion surgery.
The key is the right diagnosis. Most people over age 40 will have degenerative changes on their spine x-rays, however very few of these people have significant back pain. Thorough evaluation and review of x-rays and MRIs is important to treat the pain generator.
Will spinal fusion surgery result in reduced mobility?
Even in a successful one level spinal fusion, there is significant motion loss.
What Alternatives are there to Spinal Fusion Surgery?
Disc replacement surgery is becoming more widely accepted as not only an alternative to spinal fusion surgery, but is now the preferred surgical option