Spinal Fusion

What is spinal fusion?

Spinal fusion is a surgery that connects two or more vertebrae in your spine (backbone). These ring-shaped bones form an interlocking column that holds your body upright. Fusing them together can reinforce your back’s structure.

There’s more than one type of surgeon that specializes in spinal fusion surgery. Neurosurgeons and orthopedic surgeons can do them, depending on the underlying condition and your specific needs.

There are many options for treating back pain and spine problems. Sometimes, treatments other than surgery are more effective or safer (with a lower chance of complications). But for some people, spinal fusion may be the best choice.

What does spinal fusion treat?

A spinal fusion can treat pain, numbness, muscle weakness and more. Weakness at any point of your spine can put pressure on your spinal cord or the spinal nerves that branch off of it. Pressure on your spinal cord or nerves can disrupt the signals traveling through them. Spinal fusion treats conditions that can affect your vertebrae or the joints or soft tissue that support and connect your vertebrae.

Some examples of conditions like this include:

• Congenital spine conditions (these are conditions you have when you’re born).
• Herniated (slipped, ruptured or bulging) disks.
• Infections in bones or soft tissue of your spine.
• Pinched nerves in your neck (cervical radiculopathy) and lower back (which can cause sciatica).
• Scoliosis (in adults and children).
• Spondylolisthesis.
• Spondylosis.
• Spinal stenosis and foraminal stenosis.
• Spine fractures and injuries.
• Tumors that affect the bones, soft tissues or nervous tissue (spinal cord or nerves) in and around your spine.

How should I prepare for spinal fusion surgery?

Once you and your surgeon agree that a spine fusion is the best treatment, there are a few more steps to make sure you’re ready to undergo surgery. Some of the most likely steps include:

• A pre-surgery medical checkup and lab tests. Your surgeon needs to be sure you’re in good health before this procedure. They’ll conduct tests to look for issues that you can’t feel or that don’t cause symptoms (like high blood pressure, clotting problems and kidney function).
• Medication review. Be sure to tell your surgical team about everything you take, including medications given you by a doctor and any vitamins, supplements or other things you take for your health. And be sure to follow your provider’s instructions about prescriptions exactly as given. It can make a big difference to the safety of your surgery and recovery.
• Support planning. You’ll have restrictions for a while after your surgery — like lifting and driving — that make it very difficult to manage on your own. You should be sure someone can help you at home until those restrictions are lifted.
• Anesthesia planning. You’ll meet with an anesthesiology team before your surgery. They’ll talk to you about anesthesia options for your surgery and which they recommend.
• Blood supply planning. Most people won’t need blood transfusions during spinal fusion surgery, but your provider may want to discuss your options beforehand as a precaution.
• Nicotine use review and recommendations. If you use tobacco in any form, your provider will ask you to quit before surgery. Nicotine use — including smoking, vaping or smokeless tobacco — can seriously disrupt your body’s ability to heal and rebuild bone tissue after (which is vital to this surgery being as effective as possible).
• Cleansing. You may receive instructions and supplies for cleansing the day of or the day before your procedure.
• Eating and drinking. Your provider will also give you instructions on stopping food and liquids (fasting) before your surgery.

What happens on the day of your spinal fusion?

First, you’ll spend time in the preparation area. During this phase:

• A nurse will prepare you for surgery by checking many things about you, your medical history, your medications and your family contacts.
• You’ll meet your anesthesia team who’ll also check things and talk with you about the surgery.
• Your surgeon or someone from the surgery team will make sure you have signed permission for surgery (consent) and will mark the site of your surgery.
• A healthcare provider will place an intravenous (IV) line into a vein somewhere on your body (usually your arm or hand). This provides quick access to give medications and fluids.

Then, they’ll wheel you to the operating room. At this time:

• The surgical team will place monitors on you to keep you safe throughout the surgery.
• Additional members of the surgical team will introduce themselves. You might be surprised by just how many people are on that team! There’s usually someone helping the surgeon called a scrub technician or nurse, another nurse who cares for you and helps the team out (sometimes called a circulator), the anesthesia team and the surgeon’s assistants.
• The team conducts an important safety check before the surgery starts.

Finally, the time has come for you to be put to sleep so the surgery can start.

What happens during the spinal fusion?

Spinal fusion surgeries vary depending on what part of your spine they’re trying to reach and what kind of fusion you’ll need. Some of the variables include:

• Approach direction. Your surgeon may access your spine from your back (posterior), front (anterior) or side (lateral), or a combination of these.
• Incision type. Some spinal fusions are best done using open surgery while others are best through a minimally invasive approach. Each has advantages and your surgeon will have talked with you about which is best for you and your special spine problem.
• Materials used. Spinal fusion commonly uses bone tissue (with hardware) to strengthen or reinforce the fusion. Your body’s natural healing process will see that bone tissue as something to build on, speeding up the process. The bone tissue might come from somewhere else in your body (autologous) or from a deceased donor, or it might be artificial bone-like material (synthetic). Your surgeon may also use hardware, like screws, plates or rods to further strengthen the fusion between the vertebrae. Be sure to talk to your healthcare provider if you have a metal allergy.
• Additional steps or procedures. You may need related procedures or steps to the surgery that addresses any issues that might be causing or contributing to your spine issues. Many of these are forms of spinal decompression surgery.

Once all the portions of the spinal fusion are complete, your surgeon will close the incision(s) with surgical staples, sutures or other means. Some types of sutures need removal, while others your body absorbs on its own. Your provider will tell you what type you have and whether you’ll need a follow-up visit to remove them.

After the surgery is over, your care team takes you to a place to recover where:

• A team helps ease you out of anesthesia, manages your surgical pain and helps make sure you’re safe to go to your hospital room.
• You can see your family, though you may have little memory of this.
• As you wake, you may notice that different tubes are in place. These may include a special tube in your bladder and lines in your veins to give you fluids and medications.

How long does spinal fusion surgery take?

Your time in the operating room includes many steps in addition to the actual time for surgery. The actual spinal fusion can take anywhere from one to five hours. The time needed for the surgery can vary depending on your specific needs and circumstances, so your provider is the best person to tell you how long your surgery could take.

What happens after spinal fusion surgery?

After your surgery, the next step depends on whether your surgery was an inpatient or outpatient procedure. An outpatient procedure means you’ll probably go home the same day or early the following day. An inpatient procedure means you’ll stay in the hospital for a few days.

Depending on the surgery you had and the reason you needed it, you may need to learn how to hold yourself and maintain posture. That can affect how you sit, stand, walk and move around. You may also need to wear a brace or support of some kind.

During your recovery, your provider will have you avoid certain activities and types of movement for a while. That means you’ll need assistance with many tasks, including some that seem simple. It’s critical that you follow your provider’s guidance on activity limitations. If you don’t understand part of the instructions, be sure to ask questions. It’s always better to ask beforehand than to do something that disrupts your recovery.

Your provider may also recommend that you undergo physical therapy after surgery. That usually starts a few weeks after your surgery. Physical therapy can help you build your strength and heal from the surgery. It can also help you adjust to any differences in how your back moves after the surgery.

What are the benefits of spinal fusion surgery?

Spinal fusion surgery can help improve your quality of life. It can help ease pain and related symptoms like tingling or numbness in your arms or legs. Less pain means that you can spend more time doing the things you enjoy. Most people who have spinal fusion surgery are happy with the results.

What are the risks or complications of spinal fusion surgery?

Most of the possible risks and complications from spinal fusion surgery are similar to any surgery, including:

• Infections.
• Bleeding.
• Pain.
• Medical or anesthesia problems.
• Wound issues.

Spinal fusion surgery is also very close to your spinal cord and nerve roots, and involves reducing movement between certain bones in your spine. While rare, there are risks and complications, like:

• Nerve pain.
• Muscle weakness.
• Paralysis.
• Reduced movement ability (because fused vertebrae can’t move independently anymore).

Because of all these factors, your healthcare provider will talk and work closely with you to determine if spinal fusion is the best option for you.

What is the recovery time of spinal fusion surgery?

Recovery from surgery is a gradual process. You’ll be able to resume many of your day-to-day activities within a few weeks after surgery. You’ll slowly resume light exercise and activities over the first few weeks. Depending on your job, you may be able to return in a few weeks to a few months. But getting the full rewards from spinal fusion surgery generally takes much longer. You’ll continue to notice benefits months after your surgery. Full recovery is normal, but it’s common for people to have reduced flexibility and movement because the fused vertebrae in their back no longer move like they did before.

When should I call my healthcare provider?

Your healthcare provider will schedule follow-up visits after surgery, and you should see them as recommended. You should also see your provider if you experience changes in your symptoms, or if your symptoms continue to disrupt your life longer than expected (your provider can tell you how long you can expect symptoms to affect your lifestyle).

You should see your healthcare provider as soon as possible or seek medical attention if you have any symptoms of infection or serious nerve or spinal cord problems.

Infection symptoms include:

• Fever.
• Swelling around the incision(s).
• Heat or warmth around the incision(s).
• Oozing or bleeding from the incision(s).
• Feeling dizzy or weak.

Nerve and spinal cord symptoms that need immediate care include:

• Tingling or numbness in your legs or feet that happens suddenly or in a way that’s noticeably different from before.
• Severe pain.
• Loss of muscle strength or any degree of paralysis in your legs or feet.

How serious is spinal fusion surgery?

Spinal fusion surgery is a serious medical procedure. Your provider will likely encourage you to try other treatments before surgery. That’s because the surgery may not be the only or best option.

But that doesn’t mean spinal fusion surgery is something to avoid. For many people, it’s the best option to treat ongoing back pain and back-related issues.

Can you live a normal life after spinal fusion?

Some people can return to their life as it was after undergoing spinal fusion surgery, but some have limitations or life changes. The main reason for this is spinal fusion makes a part of your back less flexible than it used to be. That can reduce or stop some symptoms, but a loss of flexibility or movement for more extensive fusions is common and expected. Your healthcare provider can tell you what’s most likely to be the case for you if you undergo spinal fusion surgery.

How painful is a spinal fusion?

Spinal fusion surgery itself isn’t painful, and anesthesia is a key part of managing pain during the procedure. But recovery from spinal fusion surgery can be painful. Your surgeon and other healthcare providers will work with you to manage your pain, but some amount of pain is common and expected as you recover.

If you have questions about how much pain to expect, talk to your provider. They can help you understand what you should expect vs. what needs further attention or treatment.

How many years does a spinal fusion last?

Spinal fusion surgery can be effective for years, but that can vary from person to person. Many different factors can affect how long this surgery can help. Some people need a follow-up surgery years later to re-fuse vertebrae or treat changes that happened over time after the first fusion surgery.

A note from Cleveland Clinic

Spinal fusion surgery is a procedure that links two vertebrae in your back so that they no longer move independently of each other. This can stabilize your back structure and reduce symptoms like pain, numbness or weakness in body areas further down. But spinal fusion surgery isn’t a magic cure. Experts recommend it cautiously, and your provider will likely recommend other treatments first.