Are you considering spinal fusion surgery as a way to resolve your back pain? It’s good you’re doing your homework, because there are things you should know about the procedure—and its aftermath—that might affect your decision. While most people are aware that this type of surgery is perceived negatively, it isn’t always clear why. This article is intended to address the most common concerns and questions about back fusion so that you can make an informed decision moving forward.
Six Common Questions About Spinal Fusion Surgery
1. What’s the success rate of back fusion surgery?
This is by far the most important question to ask. But what is “success”? From a patient’s perspective, success means a significant improvement in pain and minimal surgery. Using those standards, the data collected over the years about spinal fusion success rates generally indicates that fusion has a high rate of failure:
- According to the Pain Medicine Journal, the number of patients that will develop failed back surgery syndrome following lumbar spinal surgery is commonly quoted in the range of 10 percent to 40 percent, with some studies showing a failure rate of nearly half, or 46 percent.
- Nearly half of back fusion surgery patients in this study reported visiting a physician for back pain within four years after the procedure. Most patients were better for about two years after the procedure; after that, their pain gradually increased, so that by five years, many were back to their presurgical levels of pain.
- While some patients experience good clinical results in the short-term (two years), the outcome worsened significantly in the long term, with 37 percent of patients requiring reoperation.
- With each successive operation, the success rate decreases, going to 30 percent after a second surgery, 15 percent after the third, and to five percent after the fourth. (You can see some more statistics here.)
Ultimately, few patients experience complete relief from spinal fusion surgery, and most experience further breakdown in the spine (see question #2), often requiring future surgeries.
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2. What are the problems that can occur as a result of fusion?
The spine is a joint just like any other joint in your body, so if you fuse it, you lose mobility. Fusing even a single level of the spine changes the environment dramatically, which is likely to cause problems down the line.
If you take away the function of one or more levels of your spine with fusion, all the stress caused by your daily movements is transferred to the levels above and below the fused location, creating a heavy burden on these adjacent levels. For many patients, the adjacent levels may be somewhat compromised already (i.e., already partially affected by disease), and their degeneration can be rapidly accelerated. Recent research has shown that even healthy adjacent levels can be negatively impacted as a result of the transference, simply because you’re requiring the spine to work harder and work outside its normal range of motion.
This degeneration manifests as a condition called adjacent segment disease. Eventually, this condition could lead to spinal stenosis; or, a disc may wear out leading to spondylolisthesis or a herniated disc.
3. Will I become stiff as a result of the surgery?
A single-level fusion removes one joint of your spine, so you may not notice a major change in your range of motion as a result. But the more fusions you have, the stiffer you’ll become.
This happens because a fusion impacts the natural curve of your spine, “locking” you into a certain position. The curve in your back naturally changes all day long, depending on whether you’re sitting, standing, or slouching. So if you’ve been fused into a standing position, you’ll be uncomfortable sitting and slouching. If the curvature is off, it can lead to poor posture, pain, and muscle fatigue post-surgery.
4. Will I need additional surgeries?
As detailed above, the likelihood of needing additional surgery appears to be around 40 percent. Some would say, however, that this statistic is conservative, and I tend to agree. Most patients require a second and even third fusion due to accelerated degeneration of the spine and adjacent segment disease. And every time you have additional surgery, there’s more scarring, more stiffness of the spine, and less overall pain relief.
5. How dangerous is spinal fusion surgery?
There are different surgical approaches for fusion, some of which pose more risk than others. Complications as a result of surgery could require a prolonged hospital stay or additional surgery; others can be life-threatening. Surgeons tend to choose an approach they’re familiar with, in addition to considering what they feel is the safest approach for the case at hand. Currently, fusions are being performed using four different methods:
- Anterior Lumbar Interbody Fusion (ALIF)—The surgeon approaches the spine from the front, through the stomach. There’s some risk of damaging vital organs such as the bladder, kidneys, colon, and/or some major blood vessels.
- Extreme Lateral Interbody Fusion (XLIF)—The surgeon approaches through the abdominal wall, from the side. Complications vary depending on the location of the intended implant, with the most risk occurring at the L4-L5 level of your spine. Nerve injuries are a possibility.
- Transforaminal Lumbar Interbody Fusion (TLIF)—The surgeon approaches from the back of your spine, on one side or the other. There’s much less risk of damaging vital structures with this approach.
- Posterior Lumbar Interbody Fusion (PLIF)—The surgeon approaches from the back, in the middle. The same type of spinal fusion complications associated with a TLIF are also applicable to a PLIF, but the likelihood of stretching and injuring the nerve is greater in a PLIF.
All the procedures above have one complication in common: a risk of infection. There’s always a small chance that bacteria will migrate through a surgical incision and infect the wound.
6. Are there alternatives and how successful are they?
Yes, there are alternatives to spinal fusion surgery.
For a small number of patients, artificial disc replacement may be an option. However, this type of surgery works for people with a degenerated or worn disc and healthy facet joints—a description that fits only 2 to 5 percent of patients. During the procedure, a surgeon replaces the problematic disc with a new, artificial one, leaving the adjoining facet joints intact. Because your facet joints remain intact, this type of surgery preserves your natural range of motion. As a result, patients who have artificial disc replacement are four times less likely to need additional surgery due to adjacent segment degeneration as opposed to a fusion. However, most patients with a degenerated disc have facet joints that are also starting to wear down and become arthritic; if left in place they, too, will cause pain down the road and potentially require additional surgery. Also, for patients who suffer from pinched nerves as well as a worn disc, this surgery will not unpinch the nerves. But for the right patient, artificial disc replacement can be an effective option.
BalancedBack Total Joint Replacement is another option—one that works for a greater number of patients. During the BalancedBack procedure, your surgeon implants a device that replaces the worn-out joint completely, including the function of the disc and facet joints. That means you can keep moving as you normally would after surgery, without additional mechanical stress on adjacent levels of your spine. That decreases the risk of adjacent segment disease, as well as the risk of needing additional surgery down the road. And because the procedure is performed using a posterior (from the back) approach, your surgeon can directly address a number of contributing back and leg pain conditions, including pinched nerves from spinal stenosis.
Interested in the BalancedBack fusion surgery alternative?
If you’re facing the prospect of spinal fusion surgery and are searching for an alternative, we encourage you to explore the BalancedBack website, including our patient stories, surgical results, and the Knowledge Center.