A spinal fusion is surgery to weld together two or more vertebrae so they heal into one strong bone. Vertebrae are the bones that make up the spine.
Reasons for Procedure
Spinal nerves leave the spine between the vertebrae. Damage to the vertebra and the disc that sits between them can put extra pressure on these nerves. This can cause pain and weakness in the areas of the body affected by the nerve. Spinal fusion may be done when other methods have not helped. A spinal fusion removes damaged tissue and locks the two vertebrae in place to prevent irritation of the spinal nerve between the vertebrae.
This surgery is done to ease pain and improve function. Spinal fusion may be done to treat problems, such as:
Spinal fusion can be done by open surgery or using a minimally invasive technique. The exact steps will depend on the type of spinal fusion that is being done. Some examples are:
uses the surfaces in between the vertebrae for fusion. The disc in between the vertebrae is either partly or fully removed. A cage (spacer) will be placed between the vertebra where the disc was removed. The cage may be made of plastic or metal. Bone grafts are used to help the bones heal together into one solid bone. It may be from a person's own bone, one from a cadaver, or artificial bone. Metal screws and plates may then be placed on the outside of the vertebra to keep the bones stable. There are three types of interbody fusion:
Posterior lumbar interbody fusion (PLIF)—the incision is made in the back. Muscles and nerves are moved out of the way. Part of the spinal bone may be removed to access the area between the vertebrae. The cage is placed from the back of the spine.
Transforaminal lumbar interbody fusion (TLIF)—the incision is made from the side. This allows access to the vertebra without a lot of movement to the muscles and nerves. It also does not require removing any bones. The cage is placed from the side of the spine.
Anterior lumbar interbody fusion (ALIF)—the incision is made in the lower belly. Organs and blood vessels are moved aside to access the vertebra. The muscles and nerves of the spine do not have to be moved. The cage is placed through the front part of the spine. No surgery is done on the outside of the vertebra.
Another option is
posterolateral fusion . An incision is made in the back. The muscles are pushed aside to access the vertebra. Damaged bone and structures may be removed to ease pressure on spinal nerves. A graft will be placed along the outside of the vertebra to support bone healing and growth. Screws and rods may also be used to keep the bones stable while they heal.
The incision will be closed with stitches or staples.
A metal cage filled with bone graft is placed between lumbar vertebrae.
Pain and swelling are common in the first month. Medicine and home care can help.
Average Hospital Stay
Most people leave in 3 to 4 days. If you have any problems, you may need to stay longer.
At the Hospital
Right after the procedure, the staff may:
Give you pain medicine
Apply a back brace or cast
Teach you how to move, sit, stand, and walk
Physical therapy will be started soon after the procedure.
During your stay, staff will take steps to lower your chance of infection, such as:
Washing their hands
Wearing gloves or masks
Keeping your incisions covered
You can also lower your chance of infection by:
Washing your hands often and reminding visitors and staff to do the same
Reminding staff to wear gloves or masks
Not letting others touch your incisions
It will take a few weeks for the incisions to heal. It will take several months for the bones to fully fuse. Physical activity will be limited during recovery. You will need to ask for help with daily activities and delay return to work.
Anterior lumbar interbody fusion. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: https://orthoinfo.org/en/treatment/anterior-lumbar-interbody-fusion. Accessed September 30, 2020.
Chronic low back pain. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/chronic-low-back-pain. Accessed September 30, 2020.
Posterior lumbar interbody fusion and transforaminal lumbar interbody fusion. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: https://orthoinfo.aaos.org/en/treatment/spinal-fusion-plif-tlif. Accessed September 30, 2020.
Qaseem A, Wilt TJ, et al. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017 Apr 4;166(7):514-530.
Spinal fusion. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: https://orthoinfo.aaos.org/en/treatment/spinal-fusion. Accessed September 30, 2020.
Spine surgery: Lumbar interbody fusion. Hospital for Special Surgery website. Available at: https://www.hss.edu/conditions_spine-surgery-lumbar-interbody-fusion.asp#.VJMAvsAKA. Accessed September 30, 2020.
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