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Spinal Fusion - Preoperative Preparations, Procedure, and Postoperative Complications

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Spinal fusion surgery refers to the procedure where two adjacent vertebrae are fused into one solid bone using bone grafts.

Medically reviewed by

Dr. Atul Prakash

Published At November 1, 2022
Reviewed AtApril 20, 2023

Introduction:

Spinal fusion is a surgical procedure where the vertebrae are permanently joined or fused into one single solid bone with no spaces between them. The vertebrae are the small, interlocking bones of the spine collectively termed a vertebral column. Bone grafts fill the naturally occurring space between the separate vertebrae, which is filled up and sealed when the bone heals.

What Are the Types of Spinal Fusion?

  • Arthrodesis.

  • Anterior spinal fusion.

  • Posterior spinal fusion.

  • Vertebral interbody fusion.

Spinal fusion surgeries are performed to treat or relieve symptoms of many spinal problems that result in back pain due to routine activity. It is indicated primarily in discogenic pain (caused by degenerative disc changes) and spinal instabilities caused by decompressive surgical procedures. As the procedure removes mobility between vertebrae, it reduces the spine's flexibility. However, it remedies the underlying spinal disorders, thus reducing pain originating from movements. The diseases that necessitate such a procedure are as follows;

  • Tumors or growths in the vertebral column or spinal cord.

  • Stenosis of the spinal cord or nerve roots of cranial and spinal nerves.

  • Disk hernias.

  • Degeneration of the intervertebral disks caused by diseases.

  • Fracture of the vertebrae that causes instability of the spine.

  • Scoliosis or hump-like curve of the vertebral column.

  • Kyphosis or an exaggerated, forward rounding of the upper back.

  • Weakness of the spine due to disease or senescence.

  • Spondylolisthesis is where a vertebra slips onto the vertebra below it, impinging upon the spinal cord or nerves, resulting in excruciating pain.

A spinal fusion procedure may either be done alone or may include a discectomy, which involves the removal of the injured or affected disk. Bone grafts are placed into the now empty disc space created after discectomy to maintain the proper height between the bones. Then, two adjacent vertebrae on either side of the removed disk are bridged or fused across the bone grafts to stabilize the spine.

When performed in the cervical spine along with a discectomy, such a procedure is known as cervical fusion surgery, where in place of removing a vertebra, the discs or bone spurs from the cervical spine present in the neck are removed.

How Does Preoperative Preparation Look Like for Spinal Fusion?

Like any other major surgical procedure, preoperative preparation for spinal fusion surgery requires preoperative laboratory testing to determine the presence of systemic diseases and lifestyle habits that may affect the outcome of the surgery.

The conditions that may affect the short or long-term effects of the procedure are as follows;

  • Cigarette smoking may reduce the ability or prolong the time needed to heal postoperatively.

  • Consumption of alcoholic beverages.

  • Presence of preexisting disease or illnesses such as influenza or herpetic diseases.

  • Drug and allergy history of the patient.

The medications that are taken before and after the procedure should thoroughly be discussed with the consulting surgeon, who may provide special instructions in case of blood-thinning medications that could affect blood clotting and wound healing, including anticoagulants and nonsteroidal anti-inflammatory drugs (NSAIDs), such as Aspirin and Ibuprofen.

How Is Spinal Fusion Surgery Conducted?

  • Anesthesia: Spinal fusion is performed under general anesthesia. During the procedure, the blood pressure and heart rates are constantly monitored using a pressure cuff and lead on the chest, which allows the surgeon and anesthesiologist to monitor the vital signs during surgery which may take several hours.

  • Bone Grafting: A bone graft is prepared to fuse the two vertebrae, which may be derived from the patient's pelvic bone. Synthetic bone grafts or allografts may be obtained from a bone bank or a consenting donor.

  • Surgery: The surgeon makes an incision for placement of the bone, depending on the site of bone fusion. In case of a cervical fusion, a small incision is made in the horizontal fold of the front of your neck to expose the cervical spine. Then, the bone graft is placed between the affected vertebrae to fuse them. The graft material may sometimes be inserted between the vertebrae in specially fabricated cages or over the back part of the spine. Once in place, the bone graft is stabilized in position using plates, screws, and rods that prevent the spine from undesired movements by internal fixation. The additional stability provided by the plates, screws, and rods helps the spine heal faster and with a higher success rate.

  • Pain Management: It is done with medication with instructions about the new ways to move since the flexibility may be limited. One might also need to learn new techniques to walk, sit, and stand safely. A solid food diet for a few days may be avoided unless otherwise advised by the surgeon.

  • Postoperative Phase: Post-discharge from the hospital, the patient may need to wear a brace to keep the spine in proper alignment. A rest period will be advised before returning to resume everyday activities until the bone has fused into place. Complete fusing may take up to six weeks or longer with physical rehabilitation to help strengthen the back and learn ways to move safely. Full recovery from spinal fusion takes three to six months, depending upon age, overall health, and physical condition.

What Are the Postoperative Complications of Spinal Fusion?

As with any major surgical procedure, spinal fusion surgery may also carry risks of certain complications, as follows;

  • Infection of the surgical site.

  • Blood clots in the head and neck or extremities.

  • Dissemination of the blood clots to the lungs may be fatal.

  • Bleeding and blood loss may lead to death.

  • Respiratory distress.

  • Increased risk of a heart attack during an ongoing surgery.

  • Increased risk of strokes.

  • Delayed or inadequate wound healing due to systemic diseases such as diabetes.

  • Allergic or anaphylactic reactions to medications or anesthetic agents administered.

Certain rare complications may also be seen, enlisted as follows;

  • Infection in the treated vertebrae.

  • Damage to a spinal or cranial nerve or nerve root leads to weakness, pain, bowel or bladder problems, or neuralgic pain.

  • Stress on the bones adjacent to the surgically treated vertebrae due to loss of flexibility and increased stiffness.

  • Persistent pain at the donor bone graft site if an autograft is used.

  • Allergic reaction caused by synthetic bone grafts.

The most severe complications, as mentioned above, are blood clots, disseminated clots to other sites, and an infection of the surgical site, which have a high chance of occurring during the first few weeks of the postoperative recovery phase.

Removal of the hardware is necessary in case of postoperative pain or discomfort, and emergency help should be sought if one experiences any of the symptoms of a blood clot enlisted as follows;

  • Sudden swelling in the calf, ankle, or foot.

  • Redness or tenderness is seen either above or below the knee.

  • Calf pain.

  • Groin pain.

  • Shortness of breath or difficulty breathing.

A patient should seek emergency help if any of the symptoms of infection are seen, enlisted as follows;

  • Redness or swelling at the edges of the surgical site.

  • Fluid drainage such as blood or pus from the surgical site.

  • Fever, chills, or elevated body temperature over 100 degrees Fahrenheit.

  • Shaking and malaise.

What Is Minimally Invasive Spinal Fusion?

With recent advancements in almost all fields of extensive surgeries, minimally invasive spinal fusion surgeries use a smaller incision than traditional surgery, preserving the muscle attachments to the spine. As mentioned earlier, this leads to a faster recovery than conventional surgery and reduced chances for specific problems. A small incision to access the spine is made, and the back muscles are gently pushed away with a unique tool. Two or more vertebrae are then welded together using bone or other artificial materials.

Conclusion

Spinal fusion involves the fusion of a single solid bone with no spaces between them. Then, a bone graft is prepared to merge the two vertebrae, which may be derived from the patient's pelvic bone. Recent advancements such as minimally invasive spinal fusion surgeries use a smaller incision than traditional surgery, preserving the muscle attachments to the spine, which leads to a faster recovery than conventional surgery and reduced chances for specific problems.

Frequently Asked Questions

1.

Is Spinal Fusion Considered a Major Surgical Procedure?

Spinal fusion is a serious procedure. To stabilize the spine and lessen discomfort, entails connecting two or more vertebrae, which frequently necessitates a hospital stay and a recuperation period. When conservative therapy has failed to relieve a significant spinal disease or injury, it is often advised.

2.

Can Individuals Recover Completely From Spinal Fusion?

Spinal fusion is a surgical treatment that, in certain cases, can stabilize the spine and relieve pain, but the degree of recovery varies depending on the specifics of each patient. Although many people find that spinal fusion significantly improves their quality of life and reduces their pain, it's crucial to remember that "full recovery" can be a relative term. While some people may have limits, others may regain the majority of their function and lead busy lives. Rehabilitation and physical therapy can speed up healing. The purpose of the surgery, the patient's general health, and adherence to post-operative treatment are other factors that affect the result.
 

3.

Is Spinal Fusion Recovery Painful?

Recovery from spinal fusion surgery can vary greatly from person to person. The level of pain and discomfort experienced during recovery depends on several factors, including the extent of the surgery, individual pain tolerance, and how well the patient follows post-operative care instructions. In general, it's common to experience some level of pain, discomfort, and stiffness after spinal fusion surgery.This can be managed with pain medications prescribed by the surgeon.

4.

What Is the Spinal Fusion Surgery Success Rate?

The exact indication for the procedure, the surgeon's expertise, and the patient's general health can all affect the success rate of spinal fusion surgery. For many patients, spinal fusion is generally regarded as a successful treatment that can offer relief from issues like spinal instability, herniated discs, and degenerative disc degeneration. Success is frequently judged by things like less discomfort, enhanced stability, and improved function. 60 % to 90 % of surgeries are successful, with higher success rates frequently occurring when the surgery is well-indicated and carried out by skilled surgeons.

5.

What Is the Duration of Bedrest After Spinal Fusion Surgery?

Following spinal fusion surgery, the amount of time spent in bed can vary based on the particular treatment, the surgeon's recommendations, and the patient's unique circumstances. On the first or second day following surgery, patients are frequently urged to get out of bed and begin walking with help in order to avoid issues like blood clots and muscle atrophy. While recovering fully from spinal fusion surgery might take several months, patients may need to avoid specific activities and adhere to a rehabilitation schedule throughout this time.

6.

Can individuals live without spinal fusion surgery?

Many people are able to survive without having spinal fusion surgery. When certain medical issues, such as severe spinal instability or deformity, exist, spinal fusion is frequently advised. Physical therapy, medicines, lifestyle changes, and less invasive surgical methods are just a few of the non-surgical therapies and treatments that are available to manage spinal disorders. The underlying condition and a doctor's suggestions determine if spinal fusion surgery is necessary.

7.

Why Is Spinal Fusion Surgery Expensive?

The cost of spinal fusion surgery is primarily caused by a number of factors. A highly competent medical team, comprising surgeons, anesthesiologists, and nurses, who need specialized training and experience, is first and foremost required. Second, the procedure frequently calls for sophisticated medical tools and technology, including imaging equipment, implants, and surgical instruments. The procedure may also take a while, necessitating the use of an operating room and staff for a considerable amount of time. The whole cost is increased by post-operative care, which includes hospital stays and rehabilitation. Additionally, the cost is increased by the development of new spinal fusion methods and materials.

8.

What Is the Duration of Spinal Fusion Surgery?

The complexity of the operation and the number of levels of the spine involved can affect how long the spinal fusion process takes. It normally takes between two and six hours on average. On the other hand, more complicated cases could require more time; the surgeon can give a more precise estimate based on the particular ailment and surgical strategy.

9.

Which Is Better Disc Replacement or Spinal Fusion Surgery?

Depending on the patient's needs and unique condition, disc replacement or spinal fusion surgery may be the best option. A damaged spinal disc is replaced with an artificial one during disc replacement, maintaining the normal movement of the spine. Patients with good spinal stability and single-level disc degeneration are frequently advised to get it. Contrarily, spinal fusion joins two or more vertebrae to stabilize the spine and is frequently done to treat disorders like severe spinal abnormalities or problems with numerous levels of the disc. Spinal fusion offers additional stability while disc replacement improves mobility. In order to choose the best course of action, patients should speak with their medical professionals and take into account their age, general health, and the severity of their spinal condition. Both treatments offer advantages, thus the decision should be made depending on individual circumstances.

10.

Which Individuals Benefit From Spinal Fusion and Who Should Avoid Spinal Fusion?

The efficacy of spinal fusion as a surgical treatment for treating different spinal diseases relies on the patient and condition in question. People with significant spinal instability, degenerative disc disease, spinal fractures, or scoliosis-related abnormalities may benefit from it. Those who are suffering from incapacitating pain or neurological symptoms and have tried all non-surgical methods may find relief. However, not everyone is a good candidate for spinal fusion. Patients who only have little symptoms or who are looking for temporary relief from back pain should first choose conservative therapy. Additionally, due to increased dangers and minimal benefits in these situations, people who smoke, have several health conditions or have excessive expectations should refrain from spinal fusion.

11.

Can Spinal Fusion Be Removed in Individuals?

Through a process known as spinal fusion revision or removal surgery, people' spinal fusions can occasionally be removed. When difficulties, hardware concerns, or the need to remedy problems with the fused parts arise, this is often done. The choice should be taken after consulting with a spine specialist who can evaluate the particular circumstances, as it is a risky and complicated treatment.

12.

Can the Individuals Have an MRI After Spinal Fusion Surgery?

After having spinal fusion surgery, people can have an MRI (magnetic resonance imaging), but there are important safety precautions and factors to take into account. Implanting metal hardware, such as screws and rods, during spinal fusion can cause interference with the MRI's strong magnetic fields. Patients must disclose their spinal fusion to their medical professionals and the MRI technologists, as different metals may react differently in the MRI environment.
 
Dr. Atul Prakash
Dr. Atul Prakash

Orthopedician and Traumatology

Tags:

spinal fusion
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