• Published on 07 February 2019

Limitations on Mobility after Spinal Fusion

Limitations on Mobility after Spinal Fusion

February 7

Understanding the Spinal Fusion Procedure

The goal of spinal fusion is to connect adjoining vertebrae by using techniques developed from researching the actual healing process that broken bones undergo. Bone-compatible materials made from bone grafts or bone substitutes will be inserted between the vertebrae targeted for fusion. Surgical screws, rods or metal plates are used to hold the vertebrae together. In more complex cases, two or more interlocking vertebrae may be involved in the spinal fusion procedure. The results of a fusion are permanent. When the bones fuse as intended, it changes the natural mobility of your spine, affecting the area around the surgical site and in various body parts as well. By immobilizing sections of the spine, nerves, ligaments, and tissues that may have been causing or exacerbating your back pain will no longer stretch or even more.

Complications and Downsides to Spinal Fusion

This permanent solution cannot be reversed or modified at a later date, although corrective interventions often become necessary down the road. Immobilization of the spine in this manner exerts pressure on the bones above and below the fused segment, introducing new issues. Over time, this stress on the vertebrae will increase spinal degeneration, leading to the need for corrective surgery. Spinal fusion, by its very nature, involves extensive bone work. The procedure includes exposing the sides of the vertebrae, which means the surrounding muscles will have to be dissected and repaired, leading to extended downtime and a lengthy recovery process. Since the procedure involves the introduction of bone grafts and/or bone substitutes to the body, there is a very real possibility that inflammation may occur with subsequent scarring and creating new pain the surrounding area. Failed back surgery syndrome is a term used to describe the condition where lower back pain persists after surgery. Experts estimate that over 20 percent of spinal fusion surgeries may result in failed back surgery syndrome, and the risk is higher when the spine surgery involves fusion of three or more vertebrae segments. The risk for lumbar pseudoarthrosis resulting from a failed lumbar spinal fusion is low at 5 to 10 percent of spinal fusion surgeries, but remains a possibility for some patients. This is a condition where vertebrae fusion does not occur due to various conditions such as smoking or pre-existing conditions unrelated to the lower back issues. Repeat surgery is also a possibility in cases when the pedicle screws embedded to support the fusion process break or become loose or when anterior grafts shift position. Nerve damage, although rare, is also a possibility for patients who have undergone spinal surgery. This may compromise strength and mobility of the legs along with other conditions such as loss of bladder control. The biggest concern that is often overlooked when discussing spinal fusion as a solution for chronic back pain is that immobilizing sections of the spine will affect overall mobility of the individual. You may feel like a new person after recovering from the surgery, but in time, the effects of altering the natural structure of your spine will show in different ways, depending on the extensiveness of the spinal surgery and your body's ability to adapt to the changes. These effects may include limited ability to bend over to perform normal torso movements, including rotations and stretches. These restrictions may limit your ability to enjoy your favorite activities and other physically demanding everyday tasks for the rest of your life. The typical candidate for a spinal fusion would be someone who has already tried other options with little or no success. Before committing to treatment that permanently alters the flexibility of your vertebrae, it may be prudent to discuss alternative treatments with your medical team.

Alternative Treatments

If you are faced with degenerative disc disease, you should be aware that spinal fusion may compound the problem as fused segments may exert new pressure on adjacent sections of the spine. Ask your physician about options such as posterior dynamic stabilization, which is a treatment that aims to preserve vertebral motion while relieving pressure off the affected disc. Other possible treatments include disc replacement, disc regeneration and intradiscal electrothermal coagulation or annuloplasty. Studies published by the U.S. National Library of Medicine under the National Institutes of Health indicate modest outcomes for surgical procedures intended to alleviate back problems. In terms of pain relief and improved functionality, randomized controlled trials suggest that patients experience moderate improvements that could possibly be achieved through less invasive therapies. Deciding on the best treatment for your condition takes cooperative effort. Listen to your medical team's input and don't be shy about asking questions regarding side effects and long-term impact.

About Boris Terebuh, MD

I'm Boris Terebuh MD, Founder & Medical Director of the Regenerative Spine & Joint Center

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