Overview
When Is Surgery Needed?
Spinal fusion is needed for treating:
- Spinal stenosis
- Herniated discs
- Degenerative disc disease
- Fractured vertebrae causing instability in the spinal column.
- Scoliosis
- Kyphosis (abnormal rounding of the upper spine).
- Spinal weakness or instability caused by severe arthritis tumours, infections, etc.
- Spondylolisthesis
Who Are the Best Candidates for Surgery?
The best candidates for spinal surgery are:
- Patients in whom the source of the pain is known and it has been located using an X-ray, MRI, or CT scan.
- The patient has exhausted all conservative treatment options.
- Patients with pain caused by a particular condition, such as degenerative disc disease, spondylolisthesis, spinal stenosis, etc.
- Patients who do not smoke or use nicotine and tobacco products.
Who Should Not Consider Surgery?
One should avoid spinal fusion if they:
- Have nicotine addiction and cannot withhold before the surgery.
- Are alcoholic and cannot stop before the surgery.
- Have not tried or only tried a few conservative treatments. Surgery should be performed when no other option is available.
How to Prepare for Surgery?
- Routine check-up: The patient will need to have a physical exam from their primary care physician before surgery to be sure that their heart and lungs are healthy. A blood test, electrocardiogram (EKG), and chest X-ray may be performed.
- Stop taking blood-thinning and pain medication: Some medicines need to be continued or stopped on the day of surgery. Medicine such as blood thinners and pain relievers should be stopped at least one week before the surgery.
- Avoid alcohol: Avoid alcohol one week before and two weeks after surgery to avoid bleeding problems.
- Smoking Cessation: For a successful spinal fusion, avoid smoking. Using tobacco, including in forms such as cigarettes, e-cigarettes, vapers, cigars, pipes, and more, should be avoided. Research shows that nicotine prevents bone growth and decreases successful fusion. Spinal Fusion surgery is ineffective or fails in 40% of smokers, compared with 8% of non-smokers. If the patient has a nicotine addiction, the healthcare providers can prescribe substitutes and tobacco counselling programs.
- Fasting: Patients have to fast the night before the surgery.
Procedure
The patient will lie down (asleep) during the procedure, with a blood pressure cuff on their arm and heart monitor leads on their chest. During surgery, the surgeon and anaesthesiologist can monitor the patient’s heart rate and blood pressure.
Spinal fusion can be accomplished in one of two ways. The doctor can enter the body through the stomach, known as the anterior lumbar interbody fusion. Another way is through behind, directly above the spine, and called posterior fusion.
The bone grafts that connect two vertebrae may be received from a bone bank or the patient’s own body, usually from their pelvis. If the patient’s bone is being used, the surgeon will make an incision above the pelvic bone, extract a section of it, and close the incision. This bone graft can also be synthetic bone or an allograft.
The surgeon positions the bone graft material between the vertebrae to aid with their permanent fusion. Additionally, metal plates, screws, or rods may be used to secure the vertebrae during the bone graft healing process.
Upon the successful placement of the bone graft, the surgeon may employ plates, screws, and rods to implement internal fixation, preventing any unintended movement of the spine. This added stability, afforded by the plates, screws, and rods, promotes faster healing and enhances the likelihood of a successful outcome.
Possible Complications
General complications of any surgery:
- Infection
- Blood clots
- Inadequate wound healing
- Reactions to medications or anaesthesia
Taking Care of Yourself after Surgery
Following spinal fusion, a two to three-day hospital stay is commonly required. The patient may suffer some pain and discomfort depending on the location and degree of the surgery, but the pain is usually effectively controlled by drugs.
If the patient shows signs of infection after returning home, they should contact their doctor. The injured spine bones may take several months to mend and fuse. Doctors advise wearing a brace for some time to keep the spine properly positioned.
It is possible that the fusing of bones will take up to six weeks or longer. Physical therapy is recommended to assist the patient to strengthen their back and learn safe methods to move. It will take about months to recuperate after spinal fusion surgery. The patient’s age, overall health, and physical condition all influence how soon they recuperate and can return to their normal activities.
A physical therapist can educate the patient on how to move, sit, stand, and walk in such a way as to keep the spine properly positioned. Being physically inactive and overweight can increase the risk of spinal problems. It is advised to stick to a healthy diet and exercise regularly for a better prognosis.