Spinal fusion
Definition
Spinal fusion is surgery to join two bones or more (vertebrae) in the spine. Fusing the spine permanently joins the bones together so there is no movement between them. Spinal fusion is usually done along with other surgical procedures of the spine.
Other names used for spinal fusion surgery include interbody fusion and arthrodesis.
Description
You will be asleep and feel no pain (general anesthesia).
The doctor will make a surgical cut (incision) to view the spine. Other surgery, such as a diskectomy, laminectomy, or a foraminotomy, is almost always done first to relieve the pressure on your spinal cord or nerves. Spinal fusion may be done:
- On your back or neck over the spine. You will be lying face down. Muscles and tissue will be separated to expose the spine.
- On your side, if you are having surgery on your lower back. The surgeon will use tools called retractors to gently separate, hold the soft tissues and blood vessels apart, and have room to work.
- With a cut on the front of the neck, toward the side.
The surgeon will use a graft (such as bone) to hold (or fuse) the bones together permanently. There are several different ways of fusing vertebrae together:
- Strips of bone graft material may be placed over the back part of the spine.
- Bone graft material may be placed between the vertebrae.
- Special cages may be placed between the vertebrae. These cages are packed with bone graft material.
The surgeon may get the graft from different places:
- From another part of your body (usually around your pelvic bone). This is called an autograft. Your surgeon will make a small cut over your hip and remove some bone from the back of the rim of the pelvis.
- From a bone bank, called allograft.
- A synthetic bone substitute can also be used.
The vertebrae may also be fixed together with screws, plates, or cages. This "hardware" is used to keep the vertebrae from moving until the bone grafts fully healed.
Surgery can take 3 to 4 hours, but this will largely depend on how involved your spinal fusion is.
Why is the procedure done?
Spinal fusion is done to stabilize the spine. It is most often done along with other surgical procedures for spinal stenosis. It also may be done after diskectomy in the neck.
Other reasons for performing spinal fusion surgery are:
- Injury or fractures to the bones in the spine
- Weak or unstable spine caused by infections or tumors
- Spondylolisthesis, a condition in which one vertebrae slips forward on top of another
- Abnormal curvatures, such as those from scoliosis or kyphosis
Outlook (prognosis)
If you had chronic back pain before surgery, you will likely still have some pain afterwards. Spinal fusion is unlikely to take away all the pain and other symptoms.
Even when using MRI scans or other tests, it is hard for your surgeon to always predict which patients will improve and how much relief surgery will provide.
Losing weight and getting exercise will increase the chance of feeling better
Future spine problems are possible for all patients after spine surgery. After spinal fusion, the area that was fused together can no longer move. Therefore, the spinal column above and below the fusion are more likely to be stressed when the spine moves and have problems later. This can lead to more surgeries.
Reviewed By: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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