Spinal Fusion
OrthoGeorgia Spine Center
The OrthoGeorgia Spine Center provides the highest level of care to patients suffering from all spine related conditions, from the neck to the lower back. Our surgeons and physiatrist work with a highly skilled team of physician assistants and nursing professionals to provide patients with state-of-the-art spine care.
Information for Spinal Fusion Patients
The following is a series of the most frequently asked questions regarding spinal fusion. The answers are for the average case, with the understanding that there may be unusual circumstances, which would cause any one of these answers to be changed significantly. You need to understand from your orthopedic surgeon whether there is anything unusual about your particular case and have him/her explain why the answers to some of these questions might be different in your case.
SPINAL FUSION
What is spinal fusion?
A spinal fusion can be likened to “cementing” two or more of your vertebrae (back bones) together. The reason for your pain is instability in one or more segments of your spine. The fusion is done to stabilize the unstable segments. The operation is done with various techniques, depending on the individual case, and the preference of the surgeon. The aim is to achieve a solid fusion which bridges the unstable segment of your spine. The procedure can last anywhere from 2 – 4 hours, perhaps as many as 5. An average case with the insertion of hardware takes about 3 hours.
It is impossible to give a detailed description of the exact technique, but the basic principle is that there are 2 components to the surgery. The first is placement of hardware. The unstable segment of the spine is bridged by placing metal screws above and below the unstable segment and connecting these screws with metal plates or rods (there are other types of hardware that may be used depending on the preference of the surgeon). In general, there will be two screws and one plate or rod on each side. The rods are then secured to these screws using metal nuts, providing immediate stability. The hardware holds the vertebrae in position to allow the fusion of the bone to occur. In the rare instance that the plates or screws cause irritation to a patient, they can be removed once the fusion becomes solid. There are occasions where metal is not used.
The second component is the spinal fusion. This is the most important part of the procedure as the fusion ultimately takes the stress off of the hardware once the verterbrae have fused. The unstable segment is bridged by a bone graft. The bone graft (in strips or small pieces) is placed next to the bone of the spine where the fusion is to take place. Once the incision is closed, the grafted bone begins to heal to the bone and ultimately forms a solid bar of bone, cementing one vertebra to another so that there is no motion. The bone graft may come from the pelvis of the patient, although banked bone or bone substitute is often used to decrease pain from the bone graft site. In some rare instances, the bone graft may have to come from the bone bank or other substitute when the patient does not have enough bone available to provide and adequate graft (most likely due to multiple surgeries and/or severe osteoporosis). As a rule, the bone graft would be expected to be solid in 24 weeks or less.
Before surgery, some patients are fitted with a “chairback” brace and will be required to wear it for a time period of 3 to 6 months. This is a removable brace that does not have to be worn in bed or during short intervals (nighttime bathroom break, getting a snack). It is required for patients who are going to be up for an extended period of time.
What are the risks?
1. Anesthetic Complications: You must be fully anesthetized.
2. Infection: There is a chance of infection with any operation.
3. Bleeding/Blood Clots: There is always some blood loss and a chance of post- operative blood clots with any operation.
4. Spinal Damage: Damage to the spinal cord producing paraplegia. This is extremely rare.
5. Nerve Damage: This can occur, but is very infrequent. If a nerve is damaged, it does not mean paralysis. Each spinal nerve supplies only a small group of muscles.
6. Dural Leak: This is the most common complication (5 – 10%). Because the spinal canal is so tightly bound to the spinal nerves (which are covered by a thin membrane called dura), the dura may be perforated or torn in the bone removal process. These dural tears are repaired at the time of surgery, if possible. Occasionally the leakage of spinal fluid from the dural tear can prolong the patient’s hospital stay and may even require a second operation if the repair is not successful. This second operation is seldom necessary.
7. Hardware Complications: In some cases where internal fixation devices (plates and screws) are to be used, there is always the possibility that one or more of the crews may break or the plate may come loose. This is a rare occurrence and if it does occur, in many cases it is not a problem.
8. Nonunion: In some cases, the fusion may not occur. If there is persistent pain, additional surgery may be required.
9. Expectations: The final risk is that the surgery may not give you the results you hoped it would. We hope to give you significant relief from your Spinal Fusion symptoms, but it is unrealistic to expect 100% relief. It would be wise to get a clear understanding of what you can expect from your surgery.
If you are taking aspirin, anti-inflammatory drugs or pain pills, these should be discontinued two weeks before surgery. Smoking can increase your chances of developing complications during and after surgery and decrease your chances of achieving a good fusion.
How successful is the operation?
No operation is guaranteed to be successful and there is the possibility the operation may not work. For the majority of patients, a successful operation results in the relief of about 50 – 75% of preoperative pain.
Is a blood donation necessary?
In almost all cases, it is necessary to have blood available for transfusions during and after surgery. In addition a “cell saver” is used to collect the blood during from expected bleeding during surgery and about 50% of that blood can be given back to the patient during surgery in order to further reduce the requirement for a transfusion.
How long will I be in the hospital?
This varies from patient to patient. The stay averages about 3 – 5 days depending on how extensive the surgery is. Elderly patients often need to stay longer.
What should I do when I leave the hospital?
Upon discharge from the hospital, you should plan to ride home in a station wagon or van where a small mattress or pad can be put in the back of the vehicle for you to lie down (particularly for patients who will be traveling more than 20 miles). For short distances, patients may ride in a care with a reclining seat.
Most patients are able to handle 2 or 3 steps to get in their home. If you will be required to go up a flight of stairs, you will need to be assisted by two people. It is recommended that you set up sleeping quarters and remain on one floor for at least a week after arriving home.
The level of independence varies greatly by patient, but most are able to take care of their personal needs. If you have stitches or staples, you should not shower until they are removed. If your incision has been closed with buried stitches, you will have adhesive strips on your back. If there is no drainage when you leave the hospital, you may shower right away (do not try to sit down in a bathtub). When there is drainage, you will need to change the dressings and take sponge baths.
It is helpful to have some assistance with meals, household chores and child care. Do not bend over to pick up anything – bend at the knees with one hand on a piece of furniture for support. You may pick items up from tabletop height as long as they weigh no more than 15 pounds and you don’t have to carry them long.
Sexual activity is of concern to most patients. You may begin within a few days of leaving the hospital, but you should be the passive partner, on your back at the beginning of relations.
All patients will be started on some type of exercise program promptly after being discharged from the hospital. Depending on the magnitude of your surgery and your physical employment requirements, your therapy may consist of anything from exercises at home under the supervision of a physical therapist to intense rehabilitation programs followed by work hardening. Walking is strongly encouraged for those who can tolerate it, any other physical activities may be restricted and should be discussed with your surgeon.
If your job does not involve manual labor, lifting or bending, you should be able to return to work part-time in about 4 to 6 weeks. If your job requires a significant amount of manual labor, it will be several months before you will be able to return (and require that you go through an intensive rehabilitation program).
Do not allow anyone to massage the surgical area until you see your surgeon for the first post-discharge visit (3 to 4 weeks after surgery). If your incision is not draining when you leave the hospital but starts to drain after you get home, you should call your surgeon or nurse.
If there are any problems such as fever, drainage, increased weakness or return of your symptoms prior to your appointment, do not wait – call your surgeon right away.
