Sarah Lewis, PharmD
What is spinal fusion?
Spinal fusion is the surgical joining of two vertebrae in your neck or back. Your vertebrae are the bones that make up your spine (backbone). Spinal fusion permanently stops movement between two or more vertebrae. It is a treatment for a variety of diseases and spine disorders.
All spinal fusions use a bone graft to fuse or join two vertebrae. Sometimes your doctor will also use screws, rods or plates to hold your vertebrae in place. Spinal fusion can help restore pain-free function in a deformed, damaged or diseased spine.
Spinal fusion is a common but major surgery with significant risks and potential complications. You may have less invasive treatment options available. Consider getting a second opinion about all of your treatment choices before having a spinal fusion.
Types of spinal fusion
Generally, all types of spinal fusion procedures use bone graft material. This involves placing bone graft material in strips along your vertebrae, in pieces between your vertebrae, or packed into a special cage that goes between your vertebrae. Your body heals the bone around the graft over several months. Spinal fusion is not immediate with surgery. It takes time for your body to form enough bone around the graft to permanently fuse your vertebrae.
The types of spinal fusion procedures include:
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Allograft fusion uses a piece of cadaver bone for the bone graft. Allografts come from a bone bank. Allograft fusions require only one incision and cause less pain than an autograft fusion. However, bone fusion and healing is less predictable with an allograft.
Autograft fusion uses a piece of your own bone for the graft. Your doctor will usually take bone from your hip. This type of spinal fusion was the only option available in the past. However, an autograft requires an additional incision, lengthens surgery time, and causes more post-operative pain.
Synthetic or artificial graft fusion uses synthetic (totally man-made) materials and modified natural bone. Some artificial bone graft materials are used alone and others are combined with an allograft or autograft.
Other procedures that may be performed
Your doctor may also perform other procedures in addition to spinal fusion. These procedures are usually done first and include:
Discectomy is the surgical removal of part or all of a spinal disc. A discectomy treats degenerated, herniated or ruptured spinal discs.
Foraminotomy is the widening of the opening where the nerve roots leave the spinal canal. Your doctor may use this procedure when the opening (foramina) is narrowed causing pressure on the spinal nerves.
Laminectomy is the removal of the lamina. The lamina is the back part of each vertebra of your spine. A laminectomy makes your spinal canal larger. This reduces pressure in your spinal canal and nerves.
Why is spinal fusion performed?
Your doctor may recommend spinal fusion to treat a variety of diseases and spine disorders. Your doctor may only consider spinal fusion if other treatment options with less risk of complications are not working. Ask your doctor about all your treatment options and consider getting a second opinion.
Your doctor may recommend spinal fusion for persistent spinal pain caused by the following spine disorders:
Degenerative disc disease, a breakdown of the cushioning discs between the vertebrae. This can lead to compression of the spinal cord and nerves.
Fracture of a vertebra
Infections of the spine
Scoliosis or kyphosis, which are abnormal curvatures of the spine
Spinal stenosis, which is a narrowing of the spinal column causing pressure on the spinal cord and nerves
Spondylolisthesis, which is dislocation of one vertebra over the one below it
Tumors of the spine
Who performs spinal fusion?
Orthopedic surgeons and neurosurgeons perform spinal fusion. Orthopedic surgeons specialize in the surgical treatment of diseases of the bones and connective tissues. Neurosurgeons specialize in neurological surgery involving the brain, spine and nerves.
How is spinal fusion performed?
Your doctor will lead the surgical team and perform your spinal fusion in a hospital. Your surgeon will place bone graft material in strips along your vertebrae, in pieces between your vertebrae, or packed into a special cage that goes between your vertebrae.
Surgical approaches to spinal fusion
Spinal fusion surgery may be performed using one of the following approaches:
Minimally invasive surgery involves inserting special instruments and an arthroscope through small incisions in your back. An arthroscope is a thin, lighted instrument with a small camera. The camera transmits pictures of the inside of your body to a video screen viewed by your surgeon as he or she performs the surgery. Minimally invasive surgery may have a faster recovery and less pain. This is because it causes less damage to tissues. Your surgeon will make small incisions instead of a larger one used in open surgery. Surgical tools are threaded around muscles and other structures instead of cutting through or displacing them as in open surgery.
Open surgery involves making a larger incision in your back (posterior approach), abdomen or chest (anterior approach), or side (lateral approach). Open surgery allows your surgeon to directly view and access the surgical area. Open surgery requires a larger incision and involves more cutting and displacement of muscle and other tissues. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery because it causes more trauma to tissues. Despite this, open surgery may be a safer or more effective method for certain patients.
Your surgeon will determine which type of surgery is best for you and how long you need to stay in the hospital or surgical center based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different spinal fusion procedures and ask why your surgeon will use a particular type for you.
Types of anesthesia that may be used
Your surgeon will perform spinal fusion using either regional anesthesia or general anesthesia, depending on the specific procedure.
General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain. You may also receive a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.
Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. To numb a smaller area, your doctor injects the anesthetic in the skin and tissues around the procedure area (local anesthesia). You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.
What to expect the day of your spinal fusion
The day of your surgery, you can generally expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. The surgical team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.
A surgical team member will start an intravenous (IV) line.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube will be placed in your windpipe to protect and control your breathing during general anesthesia. You will not feel or remember this or the surgical procedure as they happen.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of spinal fusion?
As with all surgeries, spinal fusion involves risks and potential complications. Complications may become serious and life threatening in some cases. Complications can develop during the procedure or throughout your recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.
Infection and septicemia, which is the spread of a local infection to the blood
Potential complications of spinal fusion
Complications of spinal fusion can be serious and include:
Nerve and blood vessel damage
Pain at the bone graft harvest site
Pseudoarthrosis, a condition in which there is not enough bone formation to support the graft. This complication is more common in people who smoke. If it occurs, a second surgery may be needed to correct it.
No relief of pain or worsening of your symptoms
Recurrent spinal symptoms
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my spinal fusion?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome. You can prepare for a spinal fusion by:
Answering all questions about your medical history and medications you take. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing varies depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing weight before the surgery through a healthy diet and exercise plan.
Not eating or drinking just prior to surgery as directed. Your doctor may cancel your surgery if you eat or drink too close to the start of the procedure because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. For spinal fusion, this may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. Your doctor will give you instructions for taking your specific medications and supplements.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need a spinal fusion? Are there any other options for treating my condition?
Which type of spinal fusion do I need?
How long will the surgery take? When can I go home?
What kind of restrictions will I have after the surgery? When can I return to work and other activities?
What kind of assistance will I need at home?
What kind of rehabilitation program and physical therapy will I need?
What medications will I need before and after the surgery? How do I take my usual medications?
How will you manage my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my spinal fusion?
Knowing what to expect can help make your road to recovery after spinal fusion as smooth as possible.
How long will it take to recover?
You will stay briefly in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
If your spinal fusion involved incisions or cuts in your chest, you may have a chest tube to drain fluids from your chest. Your doctor will usually remove this tube within 24 to 48 hours. In most cases, a hospital stay of three to four days is required. Some patients, such as older adults, may need to stay briefly in a rehabilitation facility.
Recovery after surgery is a gradual process. Growth of enough new bone to stabilize your spine can take several months. Recovery time varies depending on the specific procedure, type of anesthesia used, your general health, age, and other factors. Your doctor will tell you when you can return to work and other activities.
You may need to wear a back brace for several weeks after your surgery. Your doctor will also likely refer you to an exercise rehabilitation program to help you recover. Full recovery times range from several months to a year.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor and care team will treat your pain so you are comfortable and can get the rest you need. Contact your doctor if your pain gets worse or changes because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after surgery. Call your doctor if you have any questions or concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Calf pain, or swelling of the calf, ankle or foot
Change in alertness, such as passing out, dizziness, unresponsiveness, or confusion
Chest pain, chest tightness, chest pressure, or palpitations
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate or have a bowel movement
Pain that is not controlled by your pain medication, worsening pain, or pain that is different or occurs in a new area, such as in your leg
Unexpected drainage, pus, redness, tenderness or swelling of your incision
Weakness, numbness or difficulty moving a part of your body
How might a spinal fusion affect my everyday life?
Spinal fusion may cure your condition or significantly reduce your symptoms so you can lead an active, normal life. For example, spinal fusion may relieve or lessen your pain and restore strength to your back. However, you may lose some flexibility in your spine. Also, spinal fusion will not prevent your spine from becoming damaged again. You can help prevent further spine problems by:
Following your doctor’s instructions about how to move, walk, sit and stand
Maintaining a healthy lifestyle, including an appropriate body weight
Practicing good posture
Strengthening your back muscles with exercises as recommended by your healthcare provider
Using proper body mechanics when lifting or carrying objects
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