Spinal fusion surgery joins (fuses) two or more vertebrae together with bone grafts and internal fixation devices to eventually form one solid piece of bone. The ultimate goal of the surgery is to alleviate the patient’s pain by generating bone growth which fuses the vertebrae and limits movement in that area of the spine. Spinal fusion surgery can be performed by an open incision. Dr Hsu or Dr Singh will decide whether to approach the spine through the back, abdomen, or neck, depending on the area to be fused - this will be the location of your incision.
- Bone graft used can be either from your hip or a bone bank or a combination of both. There are also bone graft substitutes now available.
- Pedicle screws, plates, or cages may or may not be used with the bone graft.
Dr Hsu or Dr Singh will decide which options are best for you depending on your specific circumstances.
The surgery is performed under sterile conditions in the operating room with the patient under general anaesthesia. Dr Hsu or Dr Singh may perform a discectomy which is the removal of the damaged disc material between the vertebrae. A laminectomy may be done which is the removal or trimming of the lamina (roof) of the vertebrae to relieve pressure on spinal nerves. Screws are then placed on each side of the vertebrae to be fused. Rods are attached to connect the screws and stabilise the spine. A bone graft (tiny bone chips) is then placed alongside and/or between the vertebrae.
It is imperative that proper spine alignment is maintained after your surgery.
After the surgery you are brought to the intensive care unit (ICU), where the medical staff monitors your vital signs and also manages your post-operative pain. Patients may experience pain at the site of incision, spasms of the neck muscles, or other symptoms. After the surgery, a cervical collar is placed on your neck.
You will be taught how to use proper body mechanics to turn in bed, reposition, stand up, sit, and walk in order to maintain the integrity of the surgical fusion while it is healing.
- You will normally stay in the hospital 5-7 days
- You will be given pain medication to make you comfortable and you may have a PCA machine: a patient controlled device to administer pain medication
- You will probably have a urinary catheter
- A postoperative rehabilitation program may be prescribed by Dr Hsu or Dr Singh
- Activities will be limited for at least 6 weeks.
The fusion process varies in each patient and can take anywhere from 6-9 months or longer.
Risks and complications
As with any major surgery there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages.
It is important that you are informed of these risks before the surgery takes place. Complications can be medical (general) or specific to spinal surgery. Medical complications include those of the anaesthetic and your general well being. Almost any medical condition can occur so this list is not complete.
- Allergic reactions to medications
- Blood loss requiring transfusion with its low risk of disease transmission
- Heart attacks, strokes, kidney failure, pneumonia, bladder infections
- Complications from nerve blocks such as infection or nerve damage
- Serious medical problems can lead to ongoing health concerns, prolonged hospitalisation, or rarely death.
Specific complications of spinal fusion surgery include:
- Urinary difficulties such as retention
- Paralytic ileus: Intestinal function may be temporarily absent or decreased
- Spinal cord injury can cause paralysis in certain areas depending on where the injury occurs
- Hardware fracture: the metal devices used for stabilisation of the vertebrae can break or move requiring additional surgery
- Implant migration: if the implant moves from where the surgeon initially placed it, a second operation may be required
- Continued or increased pain
- Sexual dysfunction if nerves to pelvic area are damaged
- Transitional syndrome: pain caused by increased wear and tear to the vertebrae adjacent to the surgical site due to increased stress in these areas
- Pseudoarthrosis: Failure of the vertebrae to fuse together causing motion between the vertebrae and increased pain.