Spinal Fusion Procedure and Reasons

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Spinal Fusion

Reviewed By: Varnada Karriem-Norwood,

SOURCES: University of Maryland Spine Center: "A patient’s guide to anatomy and function of the spine." Spine Universe web site: "Bone growth stimulation: why spine fusion surgery." Deyo, R. New England Journal of Medicine, 2004; vol 350: pp 722-726. Spine Universe web site: "Laparoscopic spinal fusion." Spine-health.com: "Lumbar spinal fusion surgery." Medline Plus medical encyclopedia: "spinal fusion." American Academy of Orthopaedic Surgeons web site: "Spinal fusion." Baptist Memorial Health Care web site: "Spinal fusion." Penn State Orthopaedics: "Spinal fusion." North American Spine Society web site: "Spinal fusion surgery." University of Maryland Spine Center: "Treatment options."

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Spinal fusion is performed on the spine to weld two or more vertebrae together, using surgical hardware and bone graft material. The spine consists of a series of interconnected bones, called vertebrae, extending from the base of the skull to the tailbone. Each vertebra connects with the one above and below at the facet joints, allowing them to move relative to one another. In between each bony vertebra lies a shock absorbing intervertebral disc. The facet joints and intervertebral discs work together to permit the bending and twisting motions of the back and neck. Protected within the vertebral column is the spinal cord, which connects the brain to the rest of the body. Spinal nerves emanate from the spinal cord at regular intervals. Your doctor may recommend spinal fusion if you have one of the following conditions. A fractured vertebra. Excessive motion between vertebrae, causing instability and pain. Spondylosis, a degenerative arthritic condition that may cause loss of normal spinal structure and function. Or spondylolisthesis, a condition in which one vertebra slips forward, relative to the one next to it. Other conditions that may require surgery include osteoarthritis of the facet joints, a spinal deformity such as scoliosis or kyphosis, or a bulging or herniated disc, which can press on the exiting spinal nerve. Spinal fusion is designed to eliminate movement between the affected vertebra, making the spine more stable and decreasing pain. Before your procedure an intravenous line will be started. A catheter may be placed in your bladder to drain your urine. Spinal fusions are done under general anesthesia, which means you will be asleep for the duration of the operation. A breathing tube will be inserted through your mouth and into your windpipe to help you breathe during the procedure. If your surgeon is using your own bone for the fusion, he or she will make an incision overlying your hip and remove a bone graft. If your bone graft is coming from another donor, it will be harvested prior to your procedure. If you're having an open procedure on the lumbar spine in your lower back, you will lie on your stomach and your surgeon will make an incision directly over the spine. If you're having surgery on the cervical spine in the neck, your surgeon will generally approach this area from the front. In some cases, a spinal fusion may be performed using a newer, less invasive laparoscopic technique. Rather than one or two large incisions, a laparoscopic spinal fusion requires several tiny keyhole incisions, through which the laparoscope and special surgical instruments are inserted. Using a high speed drill and other instruments, your surgeon will remove the disc between the two vertebral bodies to be fused. Next, your surgeon will insert the bone graft into the space between these two vertebrae. He or she may also place a plate and screws over the graft to hold the vertebrae together until they fuse into one bone. To complete the procedure, your surgeon will close the deep tissue and skin incision with stitches. Many surgeons will also place one or more drains beneath the skin that will remain in place for a few days. After your procedure you will be taken to a recovery area for monitoring. The bladder catheter will likely remain in place for several days. You may be unable to eat for a day or two after surgery and will receive fluids and nutrition through the IV. Some pain is expected during the first few days following surgery and you will be provided with pain medication to control it.