Spinal Fusion

Spinal fusion is a surgical procedure that permanently connects or "fuses" some of the bones in your spine. Your doctor may have recommended this surgery because you have back or neck pain from an injury or a medical condition such as arthritis. Ideally, the surgery eliminates motion between adjacent vertebrae where motion is causing pain. There is often a reduction of stress and pressure on nearby sensitive nerves.

Bone Grafts and Hardware
The doctor will often use some other pieces of bone to stimulate bone-to- bone healing and fusion between the spinal bones, or vertebrae. This bone can come from a bone bank or from your own body. Your pelvis or hip is usually the donor site if your doctor decides to use bone from your body.

Frequently, your doctor will use metal implants to stabilize the spine during the surgery. These implants may be rods, screws, wire loops, hooks or plates. Usually these are left in place and not removed unless they are causing some type of irritation. Such irritation is uncommon.

Complications
Your doctor should talk with you about the risks of spinal fusion. The most common problem is failure of the bones to fuse and, thus, for you to have continued pain. In this case, a repeat fusion is possible. Other risks include but are not limited to infection, breakage of the metal implant, nerve damage, blood clots, heart attack or stroke. These complications may result in continued pain, prolonged recovery and additional surgery.

Preparing for Surgery
Smoking significantly increases the chances of complications. There is a much higher failure rate for the surgery and more lung complications in smokers than in non-smokers. If you smoke, you should try to stop smoking at least 3 weeks before your surgery.

Make sure you give your doctor a list of ALL the medicines you are currently taking before the injection. This includes herbal supplements, non-prescription and over-the-counter medications, especially aspirin, NSAIDs (ibuprofen, naproxen, Motrin™, Nuprin™ Advil™, Aleve™ etc.) or other "blood thinning" medications. Aspirin and other pain relievers such as ibuprofen may cause your body to bleed more during surgery and they may also interfere with the ability of the bones to fuse.

Blood transfusions are often needed during spine fusion surgery. You should talk with your doctor about the advantages and disadvantages of donating your own blood for use during the procedure.

You will probably be instructed not to eat or drink after midnight on the day before your surgery. Unless otherwise instructed this includes water, gum, and mints. You may take required medications with a very small sip of water. You should also wash your back thoroughly with soap before the visit.

The Day of your Surgery
You will probably need to be at the surgery center or hospital a couple of hours before your surgery. The nurses may give you an intravenous (IV) line so you can receive fluids and medications during your surgery. You will be given general anesthesia that will let you "sleep" through the spinal fusion surgery.

What Happens During the Surgery?
After the anesthesia helps you go to sleep, the doctors will make an incision over the bones that need to be fused together. This incision is usually in the middle of the area over the fusion. Sometimes the incision will be slightly to the side of the neck or back. On some occasions, the doctor will also perform an anterior fusion. In this case, the doctor may make an incision through your neck, chest or abdomen. Usually the doctor will use bone grafts to stimulate healing of the bones together. As noted earlier, the surgeon may also use metal implants to stabilize the fusion area. After the grafts and/or implants are in place, the doctor will close the incision with sutures or staples.

After the Surgery
Following the surgery, you will be taken to a recovery room until you wake up from the anesthesia. This may take several hours. You will then be taken to your room in the hospital. Depending on what area of your back or neck is involved in the surgery, you may stay in the hospital between 1 and 6 days. During this time, the doctor may give you some pain medications. Pain medications may be given intravenously (IV), by injection, or by mouth.

Once you get home from the surgery, you will need to take care of yourself during your recovery process. You must follow your surgeon's orders exactly to increase the likelihood of a successful recovery. If you have had surgery on your neck, your recovery time will be about 3 to 4 months. Spinal fusion surgery on the lower back area, however, may take between 6 months and a year for a full recovery.

The complications of infection and blood clots are uncommon. If they do develop, they are most likely to occur during the first few weeks after surgery. The warning signs of infection include: fever, chills, persistent cough, burning with urination, increasing pain at the surgery site, wound drainage or redness, tenderness or increased swelling around the wound edges. The warning signs for possible blood clots include: calf, ankle, of foot swelling, calf pain or shortness of breath. If any of these symptoms develop, you should contact your doctor.

Tips to Remember for Recovery

• Make sure to take all of the medications that your doctor has prescribed for you as directed.
• Don't try to drive a car until your doctor says you can
• Learning how to move your body carefully will protect your spine and help your recovery process. When turning around, try not to twist your back or neck. Instead, use your feet to turn your body slowly around. When reaching down, bend your knees to lower you instead of doubling over at the waist. Talk with your doctor about starting a walking program to regain your strength and to keep healthy.