When Is Spinal Fusion Surgery Needed?

For most adults as they get older, experiencing back pain is a rite of passage. Somewhere along the line, the back will “go out” while moving an appliance or reaching over to pick up the laundry. Who hasn’t been laid up for a few days to recover from a back injury? When back pain becomes chronic, or it regularly interferes with daily activities… that’s when discussions of surgery, or spinal fusion, become part of the equation.

Doctors may consider spinal fusion when a patient’s spine is unstable, due to a fracture or other instability in the spine that may cause pinching. Dynamic instability occurs most often in the neck (cervical vertebrae) and the low back (lumbar vertebrae); spinal fusion surgery is most common in those regions.

“Like any surgical procedure, spinal fusion has its own risks and rewards,” said Andrew Koivuniemi, MD, PhD, neurosurgeon at Franciscan Physician Network Neurosurgery and Pain Specialists in Lafayette, Indiana. “We encourage a conservative approach to the treatment of any back pain. Often, we find that rest, therapy, and traditional pain management can bring significant relief. However, when the pain continues to limit your daily activities, surgery might be a good option to discuss.”

What Is Spinal Fusion?

Spinal fusion is a surgical procedure in which bones of the spine (vertebrae) are held together using screws and rods so that they can heal together (fuse) as one stable bone. Fusion stabilizes the portion of the spine experiencing pain and helps the bones move in their normal, healthy manner. Fusion may be completed on two vertebrae, creating one healed vertebra, or several vertebrae.

Every spinal fusion surgery is completed in as minimally invasively as possible.

“Less is more if it gets the job done,” Dr. Koivuniemi said. “Our goal is to achieve maximum benefit with minimum harm or risk to the patient.”

How Do I Prepare For Spinal Fusion Surgery?

How a patient prepares for a spinal fusion surgery can be as important as the surgery itself. Dr. Koivuniemi recommends four steps for all his patients prepping for spinal fusion:

• Stop smoking. Nicotine negatively impacts healing.
• Diabetics must have good control of their blood sugar levels. High blood sugar can cause infections.
• Overweight or obese patients should consider weight loss before surgery. Excess weight accelerates stress to adjacent parts of the spine and makes recovery from surgery more challenging.
• Stay physically active. This will prove beneficial post-surgery to help the patient hasten recovery and succeed through therapy.

What Is Recovering From Spinal Fusion Surgery Like?

Depending on how complex the surgery is, patients may stay in the hospital for a few days. Most require some form of physical therapy, starting at the bedside and then as outpatients once they have returned home. Typically, with a routine spinal fusion procedure, patients who follow doctors’ orders and successfully complete therapy can expect a return to normal activities in two to three months. However, numerous factors can affect healing and recovery including the patient’s age, physical condition, weight, and activity level.

When Should You Talk To A Surgeon About Back Pain?

Dr. Koivuniemi said consulting with a neurosurgeon might be warranted when back pain is significantly limiting your standard activities. However, he adds that he takes a conservative approach when it comes to operations on the spine.

“A patient may consider seeing a pain specialist before consulting with a surgeon because, quite often, spinal pain is best managed with physical therapy and medication,” he said. “While spinal fusion results in patient satisfaction 90 to 95 percent of the time, there are risks like any surgical procedure. In most cases, back pain is not an emergency situation requiring immediate action. That allows us time to consider the best possible conservative approach to treatment. And the patient can seek a second opinion, which we always encourage.”

Back pain is best treated conservatively. However, if pain persists, spinal fusion may prove a useful approach when the patient is in reasonable health and follows directions.