Vertebral interbody fusion; Posterior spinal fusion; Arthrodesis; Anterior spinal fusion
Spinal fusion involves surgical treatment of abnormalities in the spine bones (vertebrae), such as abnormal curvatures (scoliosis or kyphosis) or injuries (fractures).
The surgery stabilizes the back by fusing certain vertebrae together with bone grafts, with or without pedicle screws, plates, cages, or other devices.
The most common spinal area involved is the lower (lumbar) spine, but upper (cervical) spine fusion can also be performed. This surgery may be performed to treat arthritis, deformity (scoliosis, for example), instability, or trauma.
While the patient is under general anesthesia (unconscious and pain-free), an incision is made over the area of the spine that will be treated.
The lower spinal vertebrae are often repaired through an incision directly over the spine - this is called the posterior lumbar approach. The upper spinal vertebrae are often repaired through an incision in the front or side of the neck (anterior cervical spine). The middle spinal vertebrae are sometimes repaired through an incision made in the chest and abdomen (anterior thoracic spine).
Depending on the reason for surgery, the procedure may be performed through incisions made on the front, the back, or a combination of both.
The vertebrae are fused using bone grafts, with or without pedicle screws, plates, or cages.
Spinal fusion may be recommended for the following:
- Abnormal curvature of the spine o Scoliosis o Kyphosis
- Injury to the spinal vertebrae
- Protrusion of the cushioning disc between vertebrae (slipped disk, herniated nucleus pulposus)
- Weak or unstable spine caused by infections or tumors
Risks for any anesthesia include the following:
- Reactions to medications
- Problems breathing
Risks for any surgery include the following:
Additional risks include the following:
- Urinary difficulties (including urinary retention)
- Temporarily decreased or absent intestinal function (paralytic ileus)
Expectations after surgery
This surgery is usually very successful, especially with the many techniques and instruments now in use.
The patient will be hospitalized for several days after surgery. The repaired spine should be kept in proper position to maintain alignment. If the surgery involved a chest incision, a chest tube may be present to drain fulid build-up. This is usually removed after 24-72 hours.
The patient will be taught how to move properly, how to reposition, sit, stand and walk. While in bed, the patient will need to turn using a “log-rolling” technique, meaning that the entire body is moved as a unit, not twisting the spine.
There is usually considerable pain for the first few days after surgery, and pain medication will be given regularly, perhaps by patient-controlled analgesia (PCA). The patient will probably have a urinary catheter.
Because of the risk of temporarily decreased or absent intestinal function (paralytic ileus) after spinal surgery, the patient may not be able to eat for 2-3 days and will be fed intravenously.
The patient may be discharged with a back brace or cast.
by Dave R. Roger, M.D.