This article has been revised to provide the most accurate and up-to-date information.
*original publication date: February 14, 2019. Revised July 1, 2023
What is a Spinal Fusion Procedure
Spinal fusion is a surgery that connects two or more bones in your spine. This is done by packing bone grafts or substitutes between the targeted vertebral bones. Surgeons often use hardware, such as screws, rods, or metal plates to keep the bones together while they heal. Sometimes, more than two bones need to be joined together. When the bones heal, they become permanently connected and function like one solid bone. This can change how your spine moves and affect other parts of your body. By joining the vertebral bones together, it can stop pain caused by stretching nerves, ligaments, and tissues in your back that were generating pain while the vertebral bones were able to move relative to one another.
Complications and Downsides of Spinal Fusion
Spinal fusion is a surgery that can treat back pain, but it’s a big decision, because it doesn’t represent a cure. Once it’s done, you can’t go back. although corrective interventions often become necessary down the road. The surgery puts pressure on the discs above and below the fusion and can cause new problems over time. Displaced biomechanical burden on the vertebrae will increase spinal degeneration at the neighboring levels, leading to the need for further corrective surgery. Spinal fusion, by its very nature, involves extensive bone work. The procedure includes disrupting the many muscles, tendons and ligaments which originate from the targeted vertebra, contributing to the extended recovery process. There’s a risk of inflammation, scarring, and new pain in the area.
Even after surgery, you might still have pain or other problems. Failed back surgery syndrome is a term used to describe the condition where lower back pain persists after spine 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. Sometimes, the bones don’t heal like they should, which is called pseudoarthrosis, and you might need yet another surgery to address that problem. 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, especially smokers. 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 bowel or 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 manifest in different ways, depending on the extent 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 everyday physically demanding tasks for the rest of your life. The typical candidate for a spinal fusion is someone who has already tried other treatment options with little or no success. Before committing to treatment that permanently alters the mobility of your spine, it may be prudent to discuss alternative treatments with your medical team.
Alternative Treatment Options
If you are experiencing degenerative disc disease, you should be aware that spinal fusion may create a new problem because fused vertebrae may exert new forces on adjacent segments of the spine. Ask your physician about non-surgical options such as activity modification, physical therapy, independent core muscle-stabilizing exercises, and spine injection procedures. Discseel® is an exciting new non-surgical option to treat spine disc pain. This procedure injects the FDA-approved biologic, fibrin, into the discs, which immediately eals the painful disc cracks. Discseel® allows for disc healing, which ordinarily cannot occur due to inadequate blood supply to the disc. Poor blood supply is also why disc cracks cannot successfully be surgically sewn.
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.
