If you are considering spinal fusion, as a treatment for you or a loved one, it is important that you understand the surgery that is being planned. You should also be fully aware of the risks and benefits that are associated with that surgery.
A fusion is a surgical procedure that is performed to stabilize or prevent abnormal motion between the spinal vertebrae.
You can think of your spine as a stack of small bony blocks called vertebra, and between each pair of vertebrae is an intervertebral disc, connecting the vertebrae together. Along the back of this stack of blocks runs the spinal canal which contains the spinal cord with nerves exiting at each level.
This stack of bony blocks is connected together and held in place by many different layers of ligaments, tendons, and muscles which allow a limited amount of motion between each pair of vertebrae.
This slight movement at each level is what allows you to bend, twist, and turn your body.
Problems can develop when this mobility becomes unstable or is not well controlled. This may occur due to trauma or congenital deformities, or because of degenerative changes that develop over long periods of time.
Symptoms of Instability
The most common symptom of spinal instability is pain. This may be back or neck pain that occurs when muscles or ligaments are stretched or strained by the abnormal motion in your spine.
If excessive movement between the vertebrae causes pinching of the nerves you may have sciatica pain or other symptoms such as numbness or weakness in your arms or legs. If the nerves that control your bowels or bladder are being squeezed you may develop Cauda Equina Syndromewith symptoms such as constipation, urinary retention, or incontinence.
If your doctor suspects that instability is causing your symptoms he may order special xrays. Taking pictures of your spine while you are bending forward and comparing those to pictures taken while you are arching backward, can sometimes demonstrate the abnormal motion.
The goal of a spinal fusion is to prevent abnormal motion. Many different techniques and methods have been devised, each with its own set of risks and benefits that need to be considered. One approach may be less invasive and require less surgery time, while a different approach may have a lower risk of complications or failure rate.
In the past spinal fusion was generally performed by packing bone, harvested from your pelvis, between the vertebrae. Then you would be immobilized in a body cast or brace until the graft healed and became a solid connection between the vertebrae. This is often took several months and there were many problems and complications.
Modern Surgical Techniques
Modern techniques use specialized hardware to connect the vertebrae together with screws and rods, or have devices that fit between the vertebrae connecting them together. Although these were still major surgeries, these advances avoided many of the complications associated with graft failure and long periods of immobility.
The latest procedures that have been devised involve using specially designed instruments to perform your spinal fusion through very small incisions. These minimally invasive surgeries involve much less blood loss and a much faster return to normal activities. Unfortunately, the smaller incisions allow only limited visualization and room to operate, which may cause less than perfect outcomes.
The Best Surgery for You
Which surgery is best for you will depend on your exact situation. Your surgeon must consider the severity of your symptoms and the degree of instability, your overall health, and any other medical problems you may have before deciding which spinal fusion technique may be the best for you.
A responsible surgeon will select the least invasive procedure or surgery that he thinks will be effective for correcting or stabilizing the abnormal motion in your spine.
It is important that you understand the surgery that is being planned and the risks associated with that surgery. When you understand the risks and benefits you can make an informed decision about what you want to do.
The Risks of Surgery
The risks of spinal fusion include the risks of any surgery, things like bleeding, infection, and damage to nerves. These risks are generally well controlled with accepted procedures and techniques. These risks may be increased related to recently developed technology and the experience of the surgeon.
Technology is constantly evolving. Engineers, scientists, and doctors are always trying to think of better ways to do things but sometimes there are unintended consequences, and outcomes are not always what was intended. A surgery or procedure that has only been performed a few times, or a few hundred times, has increased risk.
The Risks of Spinal Fusion Surgery
Risks more specific to spinal fusion surgery would be complications related to scar tissue and problems from immobilizing a portion of the spine.
Following surgery the healing process always forms scar tissue. Smaller surgeries with less tissue damage tend to form less scar tissue, and larger surgeries with more tissue damage tend to form more scar tissue. Scar tissue may cause pain by putting pressure on nerves or the scar tissue itself may become painful.
When scar tissue formation following spine surgery causes pain by putting pressure on nerves, pain may be felt radiating into your arm or leg in whatever area that nerve serves.
When scar tissue forms across an area of mobility, such as between two vertebrae that are not fused, movement will cause painful pulling and stretching of the scar tissue. The more it is pulled and stretched, the more painful it will be.
If scar tissue forms between two vertebrae that are not fused, you may develop painful pinching that occurs with motion of your spine.
Complications related to the motion of the spine can occur because; when one area is immobilized adjacent areas will be forced to compensate for the area of stiffness. When additional stress and strain is placed on the level above and the level below your fusion, these levels may develop problems requiring a second surgery or fusion a few years later.
Benefits of Spinal Fusion
The most obvious benefit of a successful spinal fusion would be to stop painful motion. An experienced and skilled surgeon can determine the best surgery for your particular situation. He will perform as little surgery as possible to limit tissue damage but still get the job done.
A successful surgery will allow you to increase your activity, and reduce or eliminate your need for pain medications.
Prior to surgery, you should discuss with the surgeon what to expect after surgery. Does he expect you will be able to return to full activity? How soon? If he expects your activity to be limited after surgery, what will the limitations be?
Before Considering Spinal Fusion
Spinal fusion or any other major spine surgery should only be done as a last resort. You should always try or at least consider all other conservative treatments before considering spine surgery.
When conservative therapies have failed, and abnormal motion between the vertebrae can be demonstrated on xrays or other imaging studies, you may need to consider spinal fusion.
You should always discuss with the surgeon any surgery that is planned. You should understand what the surgery is, and what the expected outcome is. You should discuss the risks and benefits with the surgeon.
If you have any questions or doubts do not hesitate to request a second opinion. A confident and responsible surgeon should not have any problem at all with sending you to another surgeon for evaluation.
If two different surgeons recommended similar treatment plans, and you decide that the benefits outweigh the risks, the proposed surgery is most likely in your best interest.