Spinal Fusion: Precautions, Procedure, Outcomes, & Recovery

by Jan 10, 2019

If you’re a “just the facts” kind of person, here’s a fact you might be interested in: Spinal surgery is only between 50% and 70% effective, compared to the 90+% positive outcomes for hip and knee surgeries, where joint replacement is common. This means there’s still quite a long way to go when it comes to innovation for the spine patient suffering from back and leg pain. 

Table Of Contents

The Spinal Fusion Procedure

Spinal Fusion Precautions

Accelerated Degeneration Of The Spine
Unbalanced Posture

Common Questions About Spinal Fusion

What are the symptoms of a failed lumbar fusion?
Do you need physical therapy after spinal fusion?
How long does it take to recover from spinal fusion surgery?
How dangerous is spinal fusion surgery?
Is it worth it to have spinal fusion?
What is the success rate of spinal fusion surgery?
How long does pain last after spinal fusion?

A Spinal Fusion Alternative

Spinal fusion success rates, in particular, remain low due to a number of obstacles posed by the procedure itself. Studies have shown that fusion patients are 2-5 times more likely to undergo multiple surgeries compared to patients receiving spinal joint replacements. As time goes on, it’s becoming increasingly clear that, for the spinal fusion patient, your first surgery is not likely to be your last.  

Why? What prevents fusion surgery from being more successful? Let’s take a closer look at the spinal fusion procedure and some issues to understand if you’re considering one.

The Spinal Fusion Procedure

Your spine is a stack of bony vertebrae all connected together. Discs provide cushioning and movement between each vertebral body, and facet joints at each level of your spine control excess movement. During fusion, a surgeon removes the disc material and all or part of the facet joints, packs the space with bone graft, and then inserts spacers, screws, and rods into the bones to temporarily hold everything in place. Eventually the bone graft fuses, the body heals, and what were once two separate vertebrae are now joined as one solid mass of bone. Some patients require multi-level fusion, which means fusing more than two vertebrae. There are lots of different approaches and techniques (ALIF, TLIF, PLIF, OLIF, XLIF, etc.) but they all essentially boil down to this—take multiple bones of the back and fuse them into one big chunk.

Spinal Fusion Precautions

The spine is a joint just like any other joint in your body, so if you fuse it, you lose mobility. You could argue there are lots of joints in the spine (unlike your hip, for instance, that has just one), so what’s the big deal? Why can’t the other joints compensate for the one that was fused? To some degree, that’s true: A single-level fusion may not reduce your range of motion too much. In fact, you might not even notice it.

But there’s more to it than that. Fusing even a single level of the spine changes the environment of that level, which is likely to cause problems down the line. In fact, the real challenges associated with spinal fusion typically develop several months to several years after surgery.

Accelerated Degeneration Of The Spine

It you take away of the function of one or more levels with fusion, all of 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 outside its normal range of motion. The likelihood of needing future surgery increases as a result. 

Looking for an alternative to spinal fusion? Find out more about how BalancedBack Total Joint Replacement can eliminate back and leg pain and restore full range of motion.

Unbalanced Posture

It wasn’t until fairly recently that we began to appreciate the foundational role that every level of the spine plays in posture. In the past, surgeons would fuse levels relatively flat with little to no regard for lumbar lordosis (the natural curve of the spine). Now we realize that correcting lumbar lordosis is the difference between a patient being able to stand upright comfortably vs. constantly fighting to maintain balance. If a patient is fused in an incorrect posture, their muscles work overtime to manage the load, usually resulting in painful spasms and continued back pain.  Many surgeons learned to avoid “flat back syndrome” by adding lordosis to even single-level fusions.

But now we are learning that even these “modern” fusions cause problems. These lordotic fusions may even be worse than the flat back. Why? You stand in lordosis and sit in flexion.  When you sit, your spine naturally gives back the lordosis and flexes forward. A flat back can be miserable for standing, but might feel great sitting. A lordotic back can be great for standing, but very damaging to the adjacent levels when sitting.

So, if you’re fused in a standing position, then your seated position is unnatural. Most of us sit at work, in the car, and in front of the TV. It’s pretty easy to see the dilemma—there really is no such thing as a good or “modern” fusion.

Common Questions About Spinal Fusion

The Q&A below gives short answers to the most commonly asked questions about spinal fusion. For more in-depth information, scroll up to the preceding article, or click on the links within each answer below.

1. What are the symptoms of a failed lumbar fusion?

Symptoms of a failed fusion—where the bones don’t fuse together—include increasing pain, diminished mobility, and (sometimes) pain, numbness, and/or tingling in the leg. These symptoms could also be symptoms of adjacent segment disease, which is another consequence of fusion. Fusion is only considered a “failure” if, one year after surgery, there’s no sign of the bones fusing. Surgeons generally expect to see radiographic evidence of fusion after six months; if no such evidence exists at nine months, it’s called a “delayed union.”

2. Do you need physical therapy after spinal fusion?

Physical therapy is very helpful in the recovery phase. But don’t start too soon—you must give the fusion time before you start putting stress on the area. Some people are ready for physical therapy eight weeks after surgery; for others it’s closer to 12 weeks. Your rehabilitation program should focus on exercises that strengthen your core, back muscles, and legs (essentially everything that supports the spine), and mobility.

3. How long does it take to recover from spinal fusion surgery?

For some people it can take up to a year for the bones to fully fuse; for others it happens in 3-6 months. A typical recovery timetable would be:

  • Day of/day after surgery—patients get out of bed, start moving around and sitting up.
  • Four to six weeks—only walking and sitting; no major exercises.
  • Six weeks to five months—walking, driving, possibly returning to work in an office setting.
  • Five to six months—Manual workers return to work.

4. How dangerous is spinal fusion surgery?

Spinal fusions are not tremendously high risk compared to other types of surgeries, but if complications occur they can be devastating. Cervical spinal fusion (in the neck) has greater risk than lumbar (low back) spinal fusion, simply because the cervical spine area controls a larger portion of your body. A worst-case scenario for cervical spine complications could result in quadriplegia; a worst-case scenario from lumbar spinal fusion is paraplegia.

5. Is it worth it to have spinal fusion?

Spinal fusion is worthwhile if it is used to treat conditions that would otherwise dramatically shorten your life expectancy, such as a tumor, trauma, or major deformity. Fusion is often the the only way to address these conditions.

However, in relation to conditions that are non-life-threatening but cause pain, the answer is less clear cut. Many patients require a second and even third fusion. Every time you have additional surgery there’s more scarring, more stiffness of the spine, and less overall pain relief. In these cases, it’s a good idea to investigate your options exhaustively.

6. What is the success rate of spinal fusion surgery?

Studies have suggested that, for normal degenerative conditions, spinal fusion patients achieve approximately 60 percent relief of back pain, and have a 30 to 40 percent risk of recurrent surgery within five to 10 years. These results are markedly diminished for each progressive surgical procedure.

7. How long does pain last after spinal fusion?

Post-fusion pain varies. Severe pain from the surgery itself should be better within two to three months. Low-grade pain can last for a lifetime. Most patients feel better for about two years after the procedure; after that, their pain often begins to gradually increase again, so that by five years, many are back to their presurgical levels of pain.

A Spinal Fusion Alternative

Today, thanks to an innovative new procedure, many people with back pain have another option: BalancedBack Total Joint Replacement. Preserving mobility of the spine is critical to maintaining health and stability. BalancedBack replaces the functions of both the damaged disc as well as the facets, adding stability after the surgical procedure just like a fusion. But unlike fusion, BalancedBack addresses the root cause of your back and leg pain while maintaining mobility and, as a result, the natural balance of your spine. You can stand in lordosis, sit in flexion, and sleep in between. Because BalancedBack moves with you, the levels above and below move naturally too.

No matter how good the fusion, it’s still a fusion. And that’s a fact.

If you’d like to find out more about the BalancedBack Total Joint Replacement procedure, visit our website.

About 3Spine

3Spine is a new kind of healthcare company that vertically integrates the development, clinical research, and delivery of novel healthcare technology.  The BalancedBack Total Joint Replacement is the technology platform developed by 3Spine as an alternative to fusion for the lumbar spine.

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