Spinal fusion is a surgical procedure done by either a neurosurgeon or an orthopaedic spine surgeon. Fusion procedures can be treatment for conditions of the cervical, thoracic, lumbar, and sacral spine. Patients typically present to the surgeon's office with pain, weakness, or fracture that prompt ordering imaging to further evaluate the spine. Physicians will often order X-rays, CT scans, and MRI studies to help guide treatment of the spine.
Indications
According to the American Academy of Orthopaedic Surgeons, the indications for spinal fusion are tumor, infection, fracture, spinal stenosis, spondylolisthesis, scoliosis, and degenerative disk disease. Spinal stenosis refers to narrowing of the spine leading to pressure on the spinal cord or nerves. Spondylolisthesis refers to displacement of one vertebrae in relation to the next vertebrae.
Identification
A spinal fusion surgery aims at preventing movement of the vertebrae. The surgeon fuses multiple levels of vertebrae above and below the spinal level that has pathology. By fusing the vertebrae together, there is less movement of the ligaments and muscles around the spine. The fusion is made by making a bridge of bone graft between the levels of vertebrae involved. Bone graft can be from the patient's hip bone, from a cadaver, ceramic, or synthetic. Surgeons may have the patient wear a brace after surgery to allow the bone graft to form a fusion. Surgeons often can use metal hardware to produce an internal fixation by placing plates, screws, and rods.
Theories
The theory behind spinal fusion is derived from the idea that movement of the vertebrae is associated with pain. Fusion limits vertebral motion and therefore is thought to decrease pain. Fusions are also usually done as part of procedures that either open up the spinal canal to reduce pressure on the spinal cord and nerve roots or removal of the intervertebral discs that can compress nerves when "bulging." Spinal fusions typically help to stabilize the spine especially if other areas of bone are removed in surgeries such as laminectomies.
Complications of Surgery
All surgeries and procedures are associated with complications. Complications can include bleeding, infection, blood clots, and nerve damage according to the AAOS Comprehensive Orthopaedic Review. Some patients develop pain at the site where the bone graft is harvested at the hip. The surgery has varying levels of success in regards to preventing recurrence of symptoms. Some patients have complete resolution of symptoms, while others have recurrence of symptoms. If the spine does not fuse correctly, there can be a condition that occurs known as a pseudoarthrosis. A pseudoarthrosis is a "false joint" where there is movement of bones.
Recovery
Rehabilitation and recovery from spinal fusion can take months for the bones to heal appropriately. Usually during the early recovery period, patients begin to have an improvement in symptoms. Patients usually do physical therapy to help improve posture and keep the fused bones in proper alignment to augment healing. Patients usually have multiple follow-up appointments with a surgeon to monitor the healing process and assess for any complications.
References
- American Academy of Orthopaedic Surgeons: Spinal Fusion
- "Review of Orthopaedics (5th edition)"; Dr. Mark Miller (ed.); 2008.
- "AAOS Comprehensive Orthopaedic Review"; Dr. Jay Lieberman (ed.); 2008.
- MayoClinic.com: Lumbar Spinal Fusion
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