Spinal Fusion

Spinal fusion, also called spondylodesis or spondylosyndesis, is a surgical procedure performed by orthopaedic surgeons or neurosurgeons that permanently joins two or more vertebrae so there is no movement between them. It can be carried out at any level of the spine, cervical, thoracic, lumbar or sacral. The surgery uses bone grafting, using bone taken from the patient (autograft), from a donor (allograft), or an artificial bone substitute, to encourage the vertebrae to heal together, and hardware such as screws, plates, rods or cages is usually added to hold the bones in place while the graft fuses; placement can be guided by fluoroscopy, navigation systems or robotics. Fusion is most commonly performed to relieve pain and pressure caused by mechanical problems of the vertebrae or on the spinal cord, particularly when a disc wears out (degenerative disc disease). Other conditions treated include spinal stenosis, spondylolisthesis, spondylosis, disc herniation, spinal fractures, tumours, scoliosis and kyphosis; the greatest benefit appears to be in spondylolisthesis, with weaker evidence for spinal stenosis. Fusions may be approached from the front (anterior), the back (posterior) or both, and posterior lumbar fixation using pedicle screws is the most common technique. Because it eliminates motion at the fused segment, spinal fusion changes the normal mechanics of the spine and places additional stress on the vertebrae above and below, which over the long term can contribute to degeneration of the adjacent segments. Motion-preserving alternatives, such as artificial disc replacement, exist for selected patients.

Recovery after spinal fusion is highly variable, depending on the type of procedure and the surgeon's preferences; the average hospital stay is around 3.7 days, and some simple cervical fusions can be done as day cases. For a typical lumbar fusion, most people are up and walking the day after surgery, can begin sitting between about one and six weeks, and usually resume driving and sedentary work at around three to six weeks. Heavier lifting is generally avoided until about twelve weeks, and a return to manual work is typically between seven and twelve weeks. Rehabilitation is not mandatory but may improve functional status and low back pain.