(Spinal Arthrodesis; Vertebral Interbody Fusion)
A spinal fusion is a surgery to weld together two vertebrae. Vertebrae are the bones that make up the spine.
Reasons for Procedure
To treat persistent pain and disability caused by:
- Spinal stenosis]]> (narrowing of the canal the spinal cord runs through)
- Spinal injury
- ]]>Spondylolisthesis]]> (vertebra is out of line with the others)
- ]]>Scoliosis]]> (abnormal curve in the spine)
- Weak or unstable spine, usually due to infection or tumors
- ]]>Herniated disk]]>
Spinal fusion may be done if the treatments below do not relieve pain and disability:
- Pain medicines
- Muscle relaxants
- Physical therapy
- Injection of drugs to relieve pain and swelling
- Behavior change therapy
Imaging tests must also show a problem that can be fixed with this procedure.
Complications are rare, but no procedure is completely free of risk. If you are planning to have a spinal fusion, your doctor will review a list of possible complications, which may include:
- Incomplete fusion of the bones
- Blood clots
- Hematoma (build-up of blood in the wound)
- Nerve damage causing pain, numbness, tingling, or paralysis]]>
- Impaired bowel and/or bladder function
- Reaction to anesthesia
Factors that may increase the risk of complications include:
What to Expect
Prior to Procedure
Your doctor may do the following:
- Physical exam, especially of the back and neck
- X-rays]]>—a test that uses radiation to take a picture of structures inside the body, especially bones
- ]]>MRI]]> scan—a test that uses magnetic waves to make pictures of the spinal nerves and disks between vertebrae
- ]]>Myelogram]]>—a type of x-ray that uses dye inserted near the spinal cord to show if there is pressure on the cord or the nerves
- Possibly a ]]>CT scan]]>—a type of x-ray that uses a computer to make pictures of the bones of the spine
Leading up to your surgery:
- Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
- Arrange for a ride home and for help at home.
- Eat a light meal the night before. Avoid eating or drinking anything after midnight.
Description of Procedure
The doctor will make an incision in your back or neck. The muscles will be spread to access the spine. The doctor may fuse the bones with either:
- Grafts made from pieces of bone or bony material (The pieces of bone may be taken from pelvis [hip].)
- A small metal cage filled with bone graft material (The cage may be placed between the spinal bones.)
The doctor will implant screws and plates or rods to hold the bones in place while they fuse together. The incision will be closed with stitches or staples.
How Long Will It Take?
4-6 hours (sometimes longer)
How Much Will It Hurt?
Anesthesia will prevent pain during surgery. You will receive medicine after surgery to help manage pain.
Average Hospital Stay
3-4 days (sometimes longer depending on age, overall health, and extent of surgery)
At the Hospital
You may receive the following care at the hospital:
- Pain medicine
- Back brace or cast
- Lessons on how to properly move, sit, stand, and walk
- Lessons on how to turn in bed without twisting the spine
- Physical therapy
- Special socks or boots to help prevent blood clots
- Move and exercise your legs while in bed—You will also be encouraged to get up and walk around several times a day.
When you return home, do the following to help ensure a smooth recovery:
- Be sure to follow your doctor's instructions.
- Keep the incision area clean and dry.
- Exercise your legs while in bed. This is to improve circulation and decrease the risk of blood clots.
- Do not lift anything heavy.
- The bones and grafts fuse together over several months. During this time, your activity will be restricted.
- Only take medicine recommended by your doctor. Ask your doctor before taking any over-the-counter medicine.
- Have the stitches or staples removed in two weeks.
- Your doctor may tell you to permanently avoid heavy lifting and strenuous activities that involve lifting and twisting.
Rehabilitation may be done in a hospital or at an outpatient clinic. The program will likely include:
- Exercises to strengthen your back
- Low-impact aerobic exercises, such as walking or swimming
Time off from work ranges from 4-6 weeks to 4-6 months. It will depend on age, overall health, and the physical demands of your job.
Complete healing of the bones may take up to a year after surgery. You will likely notice less flexibility of your spine where the bones are fused. Following your rehabilitation program will speed your recovery and reduce discomfort.
Healed Lumbar Fusion
Call Your Doctor
After you leave the hospital, contact your doctor if any of the following occurs:
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
- Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or which persist for more than two days after discharge from the hospital
- Pain that you cannot control with the medicines you have been given
- Cough, shortness of breath, or chest pain
- Joint pain, fatigue, stiffness, rash, or other new symptoms
- Numbness, tingling, pain, or weakness, especially in the arms, hands, legs, or feet
- Pain, swelling in your feet, legs, or calves
- Loss of bladder or bowel function
- Pain, burning, urgency, frequency of urination, or persistent blood in the urine
In case of an emergency, CALL 911.
American Academy of Orthopaedic Surgeons
American Association of Neurological Surgeons
Canadian Orthopaedic Association
The University of British Columbia Department of Orthopaedics
AAOS clinical guideline on low back pain/sciatica (acute) (phases I and II). American Academy of Orthopaedic Surgeons (AAOS) website. Available at: http://www.guidelines.gov/summary/summary.aspx?doc_id=5369&nbr=003672&string=spinal+AND+fusion. Accessed September 9, 2005.
Deyo RA, Nachemson S, Mirza SK. Spinal-fusion surgery—the case for restraint. N Engl J Med. 2004;350(7):722-726.
Lindström, D, Omid Sadr A, Wladis A, et al. Effects of a perioperative smoking cessation intervention on postoperative complications: a randomized trial. Ann Surg. 2008;248:739-745.
Lipson SJ. Spinal-fusion surgery—advances and concerns. N Engl J Med. 2004;350(7):643-644.
North American Spine Society. Phase III clinical guidelines for multidisciplinary spine care specialists. Spinal stenosis version 1.0. National Guideline Clearinghouse website. Available at: http://www.guidelines.gov/summary/summary.aspx?doc_id=3609&nbr=002835&string=spinal+AND+fusion. Accessed September 7, 2005.
Spinal fusion. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=156&topcategory=Spine. Updated September 2007. Accessed June 25, 2008.
Spinal fusion surgery. North American Spine Society website. Available at: http://www.spine.org/articles/spinalfusion.cfm. Accessed August 30, 2005.
Last reviewed November 2009 by ]]>John C. Keel, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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