Spinal Fusion - Indications, Procedure, Risks, and Results

What Is Spinal Fusion or Spondylodesis?

Spondylodesis, also known as spinal fusion, is a surgery to relieve the pain caused by spondylolisthesis (unstable vertebrae). This surgery aims to join two or more vertebrae by eliminating the motion between them. In simple terms, spinal fusion or spondylodesis is a welding procedure to fuse unstable vertebrae and promote their healing. Hence, spinal fusion surgery eliminates painful motion and restores spinal stability. However, this surgery is only recommended when the doctor can detect the exact source of pain. Therefore, the doctor might advise the patient to undergo X-rays, CT (computed tomography) scans, and MRI (magnetic resonance imaging) scans to get an idea about the injury.

Why Is Spinal Fusion or Spondylodesis Done?

Spinal fusion or spondylodesis uses techniques that mimic the normal healing process of damaged or broken bones. For example, the doctor places a bone-like material between the two spinal vertebrae during the surgery. Spinal fusion also prevents the undue stretching of the muscles, ligaments, and nerves around the spine. The other purposes of spinal fusion surgery are listed below:

• Spinal Deformities - Spondylodesis can rectify spinal deformities, including scoliosis (lateral or sideways curvature of the spine).

• Spinal Weakness - The spine tends to become unstable if there is excessive motion between the two vertebrae. It is one of the most common adverse effects of arthritis. Hence, spinal fusion helps one to get stable spines in such situations.

• Herniated Disk - Spinal fusion also helps stabilize the spine after removing the herniated disk.

What Are Some of the Major Risks of Spinal Fusion Surgery?

Spinal fusion is a simple and safe procedure and hardly involves any risk. However, the following complications might occur in some patients:

• Infections.

• Delayed wound healing.

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• Bleeding.

• Presence of blood clots.

• The blood vessels and the nerves around the spine might become injured.

• The patient might have pain in the area from where the graft is taken.

• Recurrence of the symptoms.

• Pseudoarthrosis (a condition where there is no solid fusion due to incomplete bone fusion).

• The nerves might get damaged during the procedure.

How Should the Patient Prepare for the Surgery?

The patient does not have to make any specific preparations before the procedure. The first thing he needs to keep in mind is that the hairs over the surgical site must be trimmed. Next, the surgical area must be cleaned thoroughly with an antiseptic or soap. In addition, the doctor might conduct a nose swab test before the surgery to monitor the unhealthy bacteria. Finally, the patient must inform the doctor about his medications or other supplements. The doctor might recommend that the patient refrains from using the drugs before the procedure.

What Happens During Spinal Fusion Surgery?

The spinal fusion surgery is usually performed under general anesthesia, so the patient remains unconscious throughout the procedure. Though spinal fusion surgery can be performed using several techniques, the technique used by the doctor depends on the location of the fused vertebrae, the patient’s general health, and body shape. The spinal fusion surgery involves the following steps:

• First, the doctor makes an incision in one of the three locations listed below to access the fused vertebrae:

  • Neck or back above the spine.

  • On either side of the spine.

  • Throat or the abdomen.

• Next, the doctor prepares the bone graft, which is required for the fusion of the vertebrae. The doctor might obtain the bone graft from the bone bank or the patient’s body. The pelvis is the most commonly used site for graft. If the doctor plans to use the bone from the patient’s body, an incision is made above the pelvic bone, a small part of the bone is removed, and the incision is closed with the help of sutures.

• Finally, the doctor closes the vertebral spaces by placing the bone graft material between them. Some doctors use metal plates, screws, or rods to stabilize the vertebrae while the bone is healing.

• Sometimes, the doctor might use a synthetic substance in place of a bone graft to stimulate bone growth and healing.

What Happens After Spinal Fusion Surgery?

The patient must stay in the hospital for a day or two post-surgery. Some pain might be experienced based on the location and extent of the spinal fusion surgery. However, the pain and discomfort are mild and can be controlled using appropriate painkillers. The patient must consult the doctor immediately if experiencing the following signs and symptoms:

1. Redness.

2. Swelling in the calf, foot, or ankle.

3. Tenderness.

4. Wound drainage.

5. Shaking.

6. Chills.

7. High-grade fever.

8. Sometimes, the blood clot might travel from the bloodstream to the lungs and settle there. As a result, the patients tend to experience chest pain, coughing, and shortness of breath. In such situations, the patient must immediately consult the doctor.

The bones in the spine do not heal spontaneously, so the doctor might recommend the patient wear a knee brace for some time to keep the spine aligned. The patient can also opt for physiotherapy as it helps one to sit, stand, and walk in a position that keeps the spine aligned. In addition, the patient can take painkillers, including nonsteroidal anti-inflammatory drugs (NSAIDs), as they help overcome the pain after the surgery. Finally, the doctor might recommend walking and other light activities for a few weeks after the surgery.

What Are the Results of Spinal Fusion Surgery?

Spinal fusion surgery is a widely used treatment modality for spinal deformities and fractures. However, studies have a mixed review of spinal fusion surgery for pain that does not have an underlying cause. For example, researchers suggest that non-surgical treatments are more effective than spinal fusion surgery for a nonspecific backache. Sometimes, it becomes difficult to decipher the exact cause of back pain, even due to a herniated disk. This is because patients have pain for reasons other than those visible on the X-rays. Though spinal fusion surgery provides symptomatic relief, it does not guarantee that the patient will not develop backaches in the future. When a part of the spine is immobilized for a considerable period, the patient experiences additional stress on the areas near the fused portion. This increases the rate of spinal degeneration, and the patient might require more spinal surgeries in the long term.

Conclusion:

Spinal fusion surgery, or spondylodesis, is a common procedure that aims to restore spinal stability. However, the procedure does not permanently cure spinal problems but only provides symptomatic relief. Hence, the patient must consult the doctor and undergo the appropriate imaging tests before the surgery to prevent any complications in the future.