Lumbar Spinal Fusion
For some people who suffer with lower back pain, surgery may be the last option for helping their pain. Most doctors recommend treatments that are less invasive such as physical therapy, steroid injections, and chiropractic adjustments. If these and other methods do not work, surgery may be the best option. There are several surgeries available for treating back pain, but lumbar spinal fusion has been around for a long time and has a high success rate among patients. For anyone considering surgery, it is important to be informed and understand the risks and benefits available, as well as what to expect.
When is spinal fusion necessary?
The spine is made up of a series of bones called vertebrae. This vertebrae protects the spinal cord and nerves. What makes the spine flexible are things called discs. These are made of flexible tissue that cushions the vertebrae and protects the spinal cord from injury. Over time, those discs can dehydrate, herniate, or even tear. This can cause a chain reaction, where the vertebrae can rub together, the nerves can get crushed or even severed, and the surrounding muscles can be pulled out of place. All of these things can cause pain and other issues. Sometimes, discs are just fine, but a tumor could grow that causes the same problems. There is also something called a bone spur that can develop on a vertebrae that also causes pain and problems. These are all common problems that can lead to spinal fusion as an option. Most commonly, a diseased disc will be the cause of a spinal fusion surgery. This is especially true in the lumbar region, as that area is used daily and regularly, so those discs have much more wear over time.
Spinal Fusion Procedure
A spinal fusion surgery is a relatively simple operation. The patient is sedated and lies face-down on the operating table. A surgeon makes an incision where the diseased disc is located, and very carefully moves the surrounding tissue and nerves to expose the disc. Then, the surgeon places a special spacer that pulls the vertebrae above and below the disc out of the way. The doctor then cuts away the diseased disc, removing as much of it as possible. Then, they place something called a cage, which is filled with bone grafting material, usually taken from the same patient or a donor. They then place some other hardware that holds the vertebrae in the correct position, and screw them into place. Most surgeons also pack the area between the vertebrae with more grafting material. Then, the tissue and nerves are repositioned and the wound is closed. This procedure usually only takes an hour or so.
Spinal Fusion Recovery
After the operation, the patient usually has to stay in the hospital for a few days to make sure they aren’t straining the back and that the wound site is healing properly. Then, they can return home but have to restrict themselves to limited activity until the follow up appointment, usually set at 2 weeks from going home. This appointment is when the patient is x-rayed and tested to make sure everything is healing correctly and that the area is fusing together. In a successful surgery, the vertebrae will fuse together after a few months, cementing that area of the spine into place. This is determined through follow up visits. Most patients can return to work and normal activity after about 6 weeks, and more strenuous activity after about 3 months, depending on the level of healing.
Spinal fusion complications
Unfortunately, there are sometimes problems that can develop as a result of spinal fusion. One of the more common but less serious problems is that the surgery does not relieve pain as the doctors intended. Sometimes people experience only partial relief. They could also rarely experience more pain than before. Sometimes the hardware does not hold the spine together properly, which can cause more pain and can cause permanent nerve damage. There can also be problems with misalignment. Some patients also do not heal properly, even after several months, and so with more strenuous activity they can crack the fused area of the spine, causing other problems. These are risks that can occur, but fortunately they are not extremely common.
Benefits to Spinal Fusion
The first and most important benefit of spinal fusion is the possibility of pain relief. For many people with chronic pain, this is life-changing. Just having the ability to function on a normal level and becoming pain-free can be worth the side effects for many individuals. Especially in lumbar spinal fusion, many people experience a loss of their range of motion, but this is generally not painful. Many patients also heal well from the surgery, and can return to work shortly after. Most insurances also cover spinal fusion when they may not cover newer surgeries like disc replacement, which requires more expertise and different hardware.
Spinal Fusion Alternatives
Disc replacement is an alternative to spinal fusion, where the procedure is very similar. Instead of filling in the area where the disc once was, the surgeon places a medical grade silicone replacement disc. This is held in place by metal stud-like hardware. This surgery has also had a high success rate, but it is newer and does have different possible complications. There are also minimally invasive options for fusion or disc removal, like removing part of the disc or just some small areas of vertebrae. These can be less invasive, but also less effective. Many doctors choose spinal fusion over these depending on the situation of the patient.
Talk to your doctor
Anytime surgery is being considered, make sure to talk to your doctor. Each person has their own situation and surgery may not be right for them. Some people are not good candidates for fusion or may not be experiencing the same problems. As you learn to care for your body, your doctor can help you decide what may help you the most!