Fusion of the spine is essentially a welding together of two separate bones of the spine in order to create an environment in which two or more bones will heal or join together—just as a fracture or broken bone can mend itself. In order to facilitate the healing process, bone or bone substances are applied between the two areas of bone that are prepared for fusion.

If the bones of the spine do not heal, this condition is defined as a non-union.  Non-unions of the spine can result in pain.

However, to decrease the chances of non-union—and maximize the potential for an optimal surgical outcome—the bones of the spine (vertebrae) can be held together in a rigid position with spinal implants. Spinal implants and fusions can be performed from the back side of the body (posterior) or the front side of the body (anterior).

During a spinal fusion, bone substances are placed over and between the bones that are to be fused.  In general, these bone substances are made up of a scaffold structure for bone to “grow on,” hormone to stimulate bone growth from osteoblastic cells, and cells. 

All of these substances can be found naturally in your own body’s cancellous bone areas. The most common areas to harvest the bone are from the front of the hip for cervical surgery or the lower back side.

In a posterior (back) approach to the spine, the most widely used implants are pedicle screws with rods. In the front side (anterior) approach, the most common spinal implant used is a plate and screws. Most current spinal implants are made of titanium.  There is no evidence that spinal implants made of titanium will trigger airport security sensors (a common travel anxiety for spinal fusion patients).

When necessary, the scaffold portion of the bone can be substituted with either man made artificial substances or bone from another person—as opposed to bone harvested from the patient’s own body, which does carry its own set of risks and complications. They include: increased time of surgery, infection of the bone graft site, pain associated with the bone harvest site, bleeding and damage to blood vessels or nerves.

Bone from another person is called allograft. The use of “bone bank bone” can avoid the complications noted above that are possible with autograft (a patient’s own) bone harvesting. 
Because bone allograft is a dead substance, the cleaning process of freezing, freeze-drying, radiation, and so forth is very effective in nearly eliminating any possibility of infection.  Bone allograft, which comes in many shapes and forms and can be used for every type of spinal surgery, is available through the hospital’s “bone bank.” 

We tailor the risks and benefits of the different bone products to suit each individual patient.
Lumbar (lower back) spinal fusion surgery patients are generally admitted to the hospital after surgery.  Pain is usually controlled with a carefully monitored PCA (patient controlled analgesia) pump.  A PCA pump is a device that usually sits on a pole by the bedside. The patient uses the PCA independently, as needed. The device allows the patient to quickly and safely administer their medicine dose, so that they do not have to ask for the medicine and wait for it to be administered by the nurses.  Most patients have a PCA pump for 1-2 days following surgery.

Aided by physical therapy, the majority of patients begin to sit upright and walk immediately after surgery.  The hospital stay is usually 2- 3 days, barring any complications.

Home or outpatient physical therapy can benefit patients who have post-operative weakness or stiffness.  In general, by two weeks following spinal fusion surgery, most patients have minimal to moderate pain and only need to take occasional pain medicine.  By six weeks, most experience a significant improvement in pain and weakness and require little to no pain medication.

There is no doubt that spinal fusion surgery can vastly improve the quality of the lives of those who undergo it. Nonetheless, the procedure is not without its risks and potential complications.

Our goal is for our patients to be as informed as possible. With that in mind, before surgery, we will fully explain the risks and complications of the procedure and any questions that patients and their families might have.

Risks and complications may include: