What is Spinal Fusion
Spinal Fusion is a surgical procedure intended to join one spinal bone to another. Surgeons follow 2 steps to prepare the spine for fusion. First, a disc or facet joint is prepared for fusion by removing the cartilage and other soft tissues, and the bony surfaces roughed up. Second, hardware is placed to fixate the spine so it cannot move. Movement prevents bone growth and fusion. Once the surgeon is completed the actual “fusion” process, joining two parts together with bone, is done by you. Our bodies have a built in mechanism for healing fractures. Roughing up the bony surfaces signals your body to knit the bones together by laying down new bone. The hardware prevents movement from breaking up the new bone, and allowing the fusion process.
Three areas of the spine traditionally undergo fusion. The first is between spinal vertebral bones after removal of a disc. Discs separate the spinal bones. There are times when discs become diseased, or painful, and need to be removed. Disc are part of the structure of the spine; if you remove a structural beam in a house, you need to preplace it with some other structure. Similarly, if a disc is removed surgeons will usually replace it with an implant such as a cage. The cage holds the disc space open while your bone grows across to unite the spinal bones in fusion.
The second structure which is often fused in the spine is the facet joint. To encourage fusion of a facet joint our surgeons remove the cartilage and soft tissue from a joint, preparing it for fusion. They then place hardware to hold your facet joints still. Bone then grows across the facet joint, causing fusion.
The third type of fusion, between the transverse processes of the bones, is not widely done anymore. Most contemporary spine surgeons don’t offer this treatment today, as we have so many better, less invasive options to get better results.
Who is a Candidate
Many patients come to Phoenix Spine & Joint looking for alternatives to fusion. We work hard to find evidence based solutions that eliminate back pain in the least invasive manner possible. Fusion is permanent, involves hardware in your body, and has multiple possible complications. We try and avoid it. Nonetheless, for some patients, fusion is the best answer. We end up performing fusion surgery for patients with:
- Deformity (scoliosis)
- Painful discs that require complete removal
- Fractures resulting in instability
- Rare cases of tumor or bone infections
Again fusion is not always best. With advances in medical technology we are now able to treat more and more patients successfully without fusion. If you are in any of the following situations, fusion is not needed to resolve your back pain:
- Back pain above or below a prior fusion
- Slipped vertebrae and a narrowed spinal canal (spondylolisthesis with stenosis)
- Arthritis of the spine
- Spinal narrowing (stenosis)
- Herniated disc
The advantage for spinal fusion comes from our experience and techniques. Our spine surgeons have done thousands of spinal fusions over more than 15 years. We use minimally invasive surgical techniques. All of our surgeries are done using a microscope and a tubular retractor. This means we can make smaller incisions, and do the least damage possible to the normal tissue while completing the operation.
We also have carefully selected the products we use during the surgery. For pedicle screws and bone paste, we usually use a product from Alphatec. Although it comes from a cadaver, the paste is prepared and tested to ensure it won’t cause any harm. For the inter-spinous spacer, we use the zip plate from Aurora. There are some cool videos showing the plate here: http://www.auroraspine.us/zipUltra.php. On occasion, we use the distraction device from Coflex.
Fusion surgery usually requires 60 – 90 minutes of surgical time. There will always be 30 min for anesthesia before and after. Most patients are out of the recovery area after an hour.
The surgery is outpatient, so you go home the same day. Once home we ask patients to start walking for exercise. We expect you to take a 10 min exercise walk each day of the first week. Your walk should increase to 20 min the second week, and 30 min the third week. At that point you can begin working out, and developing your own weight routine.
Patient Education Video