Spinal fusion surgery is a drastic back surgery procedure in which two or more vertebrae are joined together, so that no individual movement occurs in the operated vertebral levels. The idea of the surgery is to permanently connect the vertebrae to each other. This creates a solid piece of bone, rather than a joint that allows independent movement.
The theory behind this practice is that nerves are being affected by movement in particular spinal levels, so by stopping all intervertebral motion, the pain will hopefully resolve. Although this makes some degree of sense in theory, real statistics for curative benefits offered by fusion are poor short-term and horrific long-term.
This essay takes a critical look at spondylodesis, also known as arthrodesis, surgery and its consequences on the human vertebral column over time.
Fusion seems to be the great universal solution for all manner of back and neck pain issues. At least that is the way some doctors perceive it, since they prescribe fusion for virtually every type of causative condition, including all of the following and more:
Fusion is used to correct general and idiopathic spinal instability.
Fusion can be used to correct serious vertebral fractures.
Fusion is the main treatment used to provide stabilization of serious scoliosis.
Fusion is the main therapy used to correct spondylolisthesis.
Fusion is often added to laminectomy or discectomy to repair the damage of an operation targeting degenerated or herniated discs.
Fusion is one of the most widely used surgical techniques on the spine, regardless of the diagnosed source of pain.
Spinal fusion has many variations, but typically involves inserting bone grafts in between the operated vertebrae. These bone grafts heal and grow to form a living organic connection between the fused vertebrae. Bone grafts may be harvested from the patient or from a cadaver donor. New technology is exploring the possibility of using artificial bone as a graft substitute.
Sometimes, additional pieces of hardware, such as plates, rods, screws and cage apparatus, are used to reinforce the bone graft or to further strengthen the fusion over several vertebral levels.
The actual spondylodesis procedure has many variations in design and practice. Some procedures are performed through an incision on the back, while others are performed through one or more incisions on the front. Some procedures are full open surgeries, while others are done using a smaller and less traumatic incisions. Even if spinal fusion is your only option, make sure to research the best surgical technique for your individual needs.
Remember, a minimally invasive approach to care will reduce the chance for many complications, decrease healing time and dramatically improve post-surgical comfort.
This procedure is usually very invasive. There are less invasive versions available, but even these still require longer recuperation time than most other spinal surgeries. Fusion recipients typically remain as inpatients for 3 to 6 days and will require extensive rehabilitation after release from the hospital. Activity is strictly restricted, to allow the bone graft to heal and form a solid bond.
The patient must take it easy for 3 to 4 months and will not be fully healed for up to 1 year. Patients should plan on being out of work for 2 to 6 months after a fusion procedure, since recovering from this form of back surgery is a long and difficult road.
If virtually any significant complication occurs, the entire process of healing can be voided. In these cases, patients often have to go though another operation to fix whatever went wrong the first (or second or third) time, bring them right back to square one all over again.
Fusion has an extremely high risk of back surgery complications, especially when reinforcing hardware is utilized.
There is a sizeable risk of infection, spinal fluid leak or nerve damage during this procedure. There is a moderate risk of continuing pain and poor surgical results. There is a risk of bone graft rejection, especially if the graft comes from a cadaver. There are always the significant risks posed by the general anesthetic, as well.
Some patients wind up worse off after fusion. They are still in pain and further restricted in their movement. Failed back surgery syndrome is a very common occurrence in postoperative fusion patients.
Even when all goes well, the inherent design of the surgery increases spinal degeneration exponentially in nearby vertebral levels. This often results in additional fusions every 5 to 9 years or so. Some patients may endure 4 or more of these horrible operations until almost their entire spine is firmly bound together, preventing all semblance of normal movement and life.
Most conscionable doctors will advise not to undergo a fusion; not if any other possible choice can be made. The spine is designed to move, not be cemented and screwed into a fixed shape. The fusion is likely to put stress on other levels of the spine, causing accelerated degeneration. If you have this procedure as a young patient, you might expect a future filled with additional back or neck pain and multiple surgeries.
In the case of huge trauma to the spine, this procedure can be a life-saver. It is also a good procedure for the correction of serious spinal curvature or dire vertebral misalignment.
In almost any other circumstance, spinal fusion surgery can do more harm than good. A wise alternative for some patients might be to investigate disc replacement surgery as a viable option for some conditions that are typically treated with combination fusion procedures..