What is a Spinal Fusion?
Has Spinal Fusion surgery been recommended as a treatment option for your lower back pain or sciatica symptoms? What is fusion surgery? When is it necessary? What kind of recovery can I expect?
What is Spinal Fusion?
Surgery to fuse the spine is the process of fixating one vertebral body to another. To connect one vertebra to another, bonding materials are used. Instruments such as screws, rods, or plates can be utilized to assist in attaching one vertebra to another. The use of bone is also typically used as a bonding substance. Typically the disc between the two vertebrae is removed and a bone graft used to fill the gap between the segments. Other stabilizing instruments such as plates or screws are used to maximize the fixation. Doing so will cause the two vertebrae to function as one long segment and therefore stops movement between the two individual vertebral bodies.
Indications for Spinal Fusion
Undergoing any type of spinal surgery is a big decision. As with any surgery, seeking more than one opinion is always recommended. Most spinal issues are resolved with conservative care including physical therapy, weight loss, medication, and injections. In some cases, however, when conservative care has failed, spinal fusion can be a reasonable treatment option.
Some of the indications for spinal fusion can include spondylolisthesis,
degenerative disc disease
, and of course trauma such as a fracture. Spondylolisthesis is a condition in which one vertebral body can start to slip forward. In significant cases, fusion is the only way to keep this slippage from progressing and impacting spinal nerves. For cases of significant degenerative disc disease, loss of the disc can result in increased sheer force between the vertebrae, leading to significant pain. For cases involving scoliosis, spinal fixation is used to help stabilize the spine and minimize the progression of the curvature.
How does Fusion of the spine work?
The goal of fusing the spine for most chronic low back issues is to stop movement from occurring between the bony vertebral segments. Discs, joints, and nerves call all be irritated with excessive movement and/or changes in segment structure. The surgery stops this movement and minimizes the irritation on the localized structures.
What can I expect following Fusion Surgery?
Just as all lower back conditions are not the same, not all fusions of the spine are the same. Depending on your condition, more than one segment may need to be fused. The number of segments fused will impact the post surgical recovery.
In addition, there are a variety of approaches the surgeon can take to access the involved segments including an anterior, lateral or posterior approach. Your surgeon will determine the best approach for your condition. Generally speaking, the more involved the surgical procedure is, the greater the potential for increased pain, inflammation, and increased length of recovery.
Following surgery you will typically stay in the hospital for 2 or 3 days. While in the hospital the physical therapist will help to teach you the best forms of movement including a log roll to get in and out of bed.
Following surgery most surgeons require the use of a brace to help minimize motion of the spine while you are healing. Prolonged bed rest is generally not recommended. Rather, short bouts of activity are encouraged.
Pain management is a key component to a successful surgical outcome. If pain is elevated, tolerance for activity is diminished. Prolonged bed rest is generally not recommended following surgery thus minimizing pain with activity is a must. Be sure to utilize pain medication appropriately to help control postoperative pain. Of course, the use of
is also encouraged to minimize local swelling and pain.
Each surgeon has their own protocol for recovery that may or may not include physical therapy. If you feel your function is limited and you feel tightness, weakness, or residual pain issues, you can request physical therapy to help you with your recovery from spinal fusion surgery.
Generally physical therapy will not begin prior to the spine completely fusing. This can take six to eight weeks. One variable that can significantly reduce bone healing is smoking. Many surgeons refuse to perform surgery on patients that smoke because of the significantly reduced rate of healing.
The focus of physical therapy following fusion surgery involves improving both flexibility and strength. Performing specific spine range of motion exercises is generally not encouraged in the early stages of healing. Stretching exercises for the hips and legs can be greatly helpful in allowing one to utilize the legs instead of the low back for movement.
As muscles act as shock absorbers, performing core strengthening exercises are also encouraged post operatively. Generally these core strengthening exercises are done in a neutral spine position and do not involve typical sit up type exercises.
Finally, walking frequently will help to not only improve function but challenge core muscles. Begin walking for short bouts, with the post operative brace, on level surfaces. As healing of the fusion is completed, weaning from the brace with walking can be done. Make sure to listen to your symptoms, progress activity slowly, and utilize ice following activity to minimize inflammation and pain.
Spinal fusion, although intimidating, can often lead to successful outcomes and a significant improvement in pain. Remember to ask your surgeon numerous questions before making the choice to have any spinal surgery and to help you completely understand the procedure and recovery.
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