At OrthoIndy we help identify the source of your back pain. Learn more about when back surgery is necessary, how a spinal fusion is performed and the recovery time after spinal fusion surgery.
Do I need a spinal fusion?
To determine whether you are experiencing symptoms related to spine problems, your physician will ask you for a complete medical history, have you describe your symptoms and conduct a physical examination and review imaging studies. While an X-ray, CT scan, and/or MRI can help, it’s the combination of your pain pattern, physical examination and imaging studies that help narrow down the problem. Ultimately, determining the correct diagnosis is the most critical step in helping patients find the best possible treatment course.
What treatments can be attempted prior to considering surgery?
Except in emergency situations, conservative medical treatments are always attempted prior to considering spine fusion surgery. Often, a surgeon may work with a nonoperative spine care provider, such as an anesthesiologist or physiatrist, to assist in trying these medical treatments.
These treatments may include medications such as steroids or NSAIDs, muscle relaxers, nerve medications, or pain pills. Physical therapy is often prescribed to optimize muscle and spine function. Injection treatments such as epidural injections may also be indicated. Surgery is only considered when a combination of such nonoperative treatments have been attempted and yet the symptoms remain bothersome.
Anatomy of the spine
The spine is made up of 24 bones, called vertebrae, which are stacked on top of one another. The seven small vertebrae that begin at the base of the skull and form the neck comprise the cervical spine. There are twelve vertebrae below this that have ribs attached, which are thoracic vertebrae. Below this are five vertebrae of the lumbar spine the low back.
The vertebrae are separated by intervertebral discs. The discs are flexible, flat and round discs and are about a half-inch thick and function to allow motion between the vertebrae and act as shock absorbers. Each of the vertebrae has a hole or passage that allows the spinal cord to travel up and down through the spine, called the spinal canal. In between each vertebra, the spinal cord branches off nerve roots to either side which then go to the rest of the body. These nerves carry information and controls in between the body and the brain.
What is spinal fusion surgery?
Spinal fusion is a surgical procedure a spine surgeon performs to fuse together two or more vertebrae, getting them to heal into one solid bone. This eliminates the motion between individual vertebrae. The goal of a spinal fusion is to eliminate or prevent spine instability.
Why would I need a spinal fusion?
A spine fusion is not necessary in most cases. Most spine surgeons try to find alternative treatments other than fusion, and with modern advances are often able to offer patients motion-preserving solutions. However, a spine fusion remains an effective treatment in some cases:
- Instability exists between the vertebrae. In cases in which the spine loses its structural integrity, a spine fusion is necessary to restore stability. An extreme example of this is a severe spine fracture. A more common condition that causes this called spondylolisthesis, which is when one vertebrae slips forward relative to another.
- Instability would be caused by decompressing nerves. In this scenario, important parts of the vertebrae sometimes need to be removed in order to remove pressure on nerves or the spinal cord. After removing these structures and taking pressure off the nerves, the vertebrae would be unstable, and so fusion is then also performed.
- Spine deformity. In cases of scoliosis or kyphosis, the alignment of the spine becomes a problem. If surgery is required for these conditions, the alignment is improved during surgery and the individual vertebrae are then fused together in that improved alignment.
How is spinal fusion performed?
Once you and your physician decide on a spinal fusion, there are general steps taken during the procedure. Surgeries will vary, depending on the location and severity of your injury.
- First, you will be placed under general anesthesia before the procedure.
- Once the anesthesia takes effect and you are positioned on the operating table, your surgeon will make an incision. Depending on which vertebrae need to be fused, your surgeon’s approach will vary. They will either make a posterior incision (back) in your neck or back directly above your spine, a lateral incision (side) on either side of your spine, or an anterior incision (front) in your abdomen to access your spine.
- A bone graft is taken either from your own body, a bone bank or a synthetic bone is used to put in between the damaged vertebrae. If it’s taken from your body, it’s usually from your pelvis. Your surgeon will make a small incision above your pelvis and take a small portion of it to use for the fusion. The bone graft material allows and even promotes the bone cells to heal together between the vertebrae. This process is identical to what happens when a fracture heals.
- Finally, metal plates, screws and/or rods may be used to help hold the vertebrae together while the bone graft heals. This process is called internal fixation. Initially after surgery, this metal fixation provides nearly all the structural support between the vertebrae. Over time as the fusion occurs, the bone itself takes over the load.
What are the possible risks of spinal fusion?
With every surgery there is a risk of complications. Spinal fusion is a safe procedure, but difficulties may still occur. Some risks of spine fusion surgery may include:
- Bleeding or blood loss
- Nerve or spinal cord injury
- Implant complications
- Nonunion – This is when the vertebrae fail to grow together, and the fusion fails. This can cause pain to recur, and the implants may loosen or even break.
- Medical complications (heart attack, blood clots, stroke, etc)
How long after spinal fusion surgery can you bend over?
After spinal fusion, you should not bend or twist your spine for at least six weeks, or until the fusion heals. If you bend or twist too early, you can damage your spinal fusion.
Spinal fusion can take as long as three months to heal. Exercise will promote healing in your back and you will likely be encouraged by your physician to begin light physical therapy anywhere between six weeks and three months after surgery.
Initially, this surgery may prevent you from bending over and decrease flexibility in your back because two of your bones are forming into one. Your muscles weaken because of the surgery, causing you to lose tone in your muscle and range of motion. This induces stiffness. but it is designed to ultimately decrease your back pain.
What is the recovery process for spinal fusion?
Recovery is an important factor in this process. If you do not take the proper time to recover from your surgery, additional strain on your other vertebrae can cause the rest of your back to suffer. Listen to your body and your physician’s instructions to experience success in your recovery.
Depending on the extent of the problem and surgery, you may be in the hospital after surgery anywhere from a few hours to a few days. The amount of pain after surgery is very subjective and depends on both the surgery itself and the patient. Modern minimally invasive techniques are used whenever possible to minimize disruption of normal tissues and reduce postoperative pain. Pain control medications may be necessary after surgery and may include muscle relaxer medications.
It is important after fusion surgery to avoid too much bending or twisting of either the neck or back (depending on the area you had surgery). Your doctor may suggest using a brace to keep your spine well-aligned. Physical therapy will help you properly sit, move, stand and walk after your fusion. Full recovery usually takes between three and six months.
The recovery time for spinal fusion surgery takes anywhere from a few days to a few months, depending on the extent of the surgery. As a result, returning to work after a spinal fusion can vary.
The fusion process can take anywhere from 3-18 months, with 6-12 months being the typical timeframe. Radiographs or X-rays are generally taken after surgery to make sure this process is occurring without complications.
Schedule an appointment
Your well-being is important to us. Click the button below or call us to schedule an appointment with one of our orthopedic specialists. If your injury or condition is recent, you can walk right into one of our OrthoIndy Urgent Care locations for immediate care. For rehabilitation and physical therapy, no referral is needed to see one of our physical therapists.