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This is a procedure which aims to join two or more vertebrae together with solid bone. The reason is usually to treat or prevent deformity and to treat back pain. Implants (screws, rods and cages) may be used to stabilise the bone while fusion takes place but the fusion process is a biological one which depends on patient factors as well as technical ones. If implants are used for the surgery they act like scaffolding while fusion takes place. If fusion fails to occur then the metalwork may fail causing increased pain.
The success of this surgery depends on whether it is being performed for sciatica (leg pain) or back pain. Most surgeons quote a 70% chance of being 70% better with regards to back pain. The chance of improvement of leg pain is much higher.
The success of this surgery depends on whether it is being performed for sciatica (leg pain) or back pain. Most surgeons quote a 70% chance of being 70% better with regards to back pain. The chance of improvement of leg pain is much higher.
How is a spinal fusion performed?
Different types of fusion include: Posterolateral fusion, Posterior Lumbar Interbody Fusion (PLIF), Transforaminal Lumbar Interbody Fusion (TLIF)
The procedure is performed under general anaesthesia and takes between 2 and 4 hours. You will be in hospital between 3 to 5 days and will mobilse after surgery with the aid of a physiotherapist. You may need a blood transfusion in the immediate postoperative period. The wound takes about 2 weeks to heal and you will need to be off work between 2 weeks and 2 months depending upon your activity and type of work.
This is a commonly performed surgical procedure which is performed from the back with the patient lying on their front. The skin and underlying muscles are cut to expose the back of the spine. Variable amounts of bone and ligament are removed until a big enough window is achieved to decompress the dural sac and nerve roots (decompression). The bone obtained from the decompression is then mixed with synthetic substances which promote bone growth. This mixture is laid down on the roughened bony surfaces of the chosen vertebrae and over time (up to 2 years) a solid mass forms and then fusion is said to have occurred. The formation of this fusion can be improved if the bones are held rigidly together. This is achieved by implanting pedicle screws into the vertebrae and connecting them with rods. Sometimes the intervertebral disc is also removed and one or two cages are inserted. These cages can be either metal or plastic (PLIF or TLIF). The muscle and skin layers are then closed.
The procedure is performed under general anaesthesia and takes between 2 and 4 hours. You will be in hospital between 3 to 5 days and will mobilse after surgery with the aid of a physiotherapist. You may need a blood transfusion in the immediate postoperative period. The wound takes about 2 weeks to heal and you will need to be off work between 2 weeks and 2 months depending upon your activity and type of work.
This is a commonly performed surgical procedure which is performed from the back with the patient lying on their front. The skin and underlying muscles are cut to expose the back of the spine. Variable amounts of bone and ligament are removed until a big enough window is achieved to decompress the dural sac and nerve roots (decompression). The bone obtained from the decompression is then mixed with synthetic substances which promote bone growth. This mixture is laid down on the roughened bony surfaces of the chosen vertebrae and over time (up to 2 years) a solid mass forms and then fusion is said to have occurred. The formation of this fusion can be improved if the bones are held rigidly together. This is achieved by implanting pedicle screws into the vertebrae and connecting them with rods. Sometimes the intervertebral disc is also removed and one or two cages are inserted. These cages can be either metal or plastic (PLIF or TLIF). The muscle and skin layers are then closed.
What are the risks?
Immediate peri-operative risks
Anaesthetic risk
this procedure is performed under general anaesthesia and your anaesthetist will explain the risks to you.
Nerve damage
There is a small risk of nerve damage during any spinal surgical procedure. This may leave you with permanent numbness, weakness or pain in the area of the leg supplied by the nerve. This risk is increased if screws or cages are used as nerves often have to be pulled to allow insertion of the devices.
Haemorrhage/Bowel damage
The front of the disc and vertebrae lies adjacent to the major abdominal blood vessels and contents. If a screw or cage penetrates the vessels then a potentially fatal complications can ensue. This is very rare.
Cauda Equina Syndrome
If there is significant post-operative bleeding then the central spinal canal can become included with severe loss of function of the bowel and bladder and lower limbs which can be permanent. This complication is rare.
Dural tear
During this surgery the lining of the nerve roots (dura) can be torn. This leads to a fluid leak which can cause headaches and necessitate compulsory flat bed rest for 2 days. The fluid leak can often obscure vision and may rarely prevent the safe completion of surgery. A simple tear may be repaired but large tears have to be packed off.
Usually the leak seals itself off and routine mobilisation can follow but occasionally the leak can persist and necessitate a return to theatre to have the leak closed. The risk is 1-10%.
Infection
Infection following spinal surgery is less common than after other types of surgery but infection in the spine can be very serious necessitating further major surgery and long term antibiotics. Infection carries the risk of nerve damage and meningitis. If metalwork becomes infected it is often impossible to eradicate the infection without removing the implants. However, the incidence of deep infection is very low.
this procedure is performed under general anaesthesia and your anaesthetist will explain the risks to you.
Nerve damage
There is a small risk of nerve damage during any spinal surgical procedure. This may leave you with permanent numbness, weakness or pain in the area of the leg supplied by the nerve. This risk is increased if screws or cages are used as nerves often have to be pulled to allow insertion of the devices.
Haemorrhage/Bowel damage
The front of the disc and vertebrae lies adjacent to the major abdominal blood vessels and contents. If a screw or cage penetrates the vessels then a potentially fatal complications can ensue. This is very rare.
Cauda Equina Syndrome
If there is significant post-operative bleeding then the central spinal canal can become included with severe loss of function of the bowel and bladder and lower limbs which can be permanent. This complication is rare.
Dural tear
During this surgery the lining of the nerve roots (dura) can be torn. This leads to a fluid leak which can cause headaches and necessitate compulsory flat bed rest for 2 days. The fluid leak can often obscure vision and may rarely prevent the safe completion of surgery. A simple tear may be repaired but large tears have to be packed off.
Usually the leak seals itself off and routine mobilisation can follow but occasionally the leak can persist and necessitate a return to theatre to have the leak closed. The risk is 1-10%.
Infection
Infection following spinal surgery is less common than after other types of surgery but infection in the spine can be very serious necessitating further major surgery and long term antibiotics. Infection carries the risk of nerve damage and meningitis. If metalwork becomes infected it is often impossible to eradicate the infection without removing the implants. However, the incidence of deep infection is very low.
Long term risks
Nerve root scarring
It is thought that the trauma of surgery may induce scarring around the nerve root following decompression. This can cause the nerve root to become stuck down and cause pain. This is a very difficult problem to treat and may necessitate steroid injections or rarely further surgery to release the nerve.
Adjacent level disease
Making one level in the spine rigid results in the transmission of forces to the levels on either side. This can instigate or hasten the degeneration of the discs or facet joints above and below the fusion. There is no consensus of opinion as to the incidence of this complication or its clinical significance i.e. degeneration does not necessarily mean that pain will be experienced or that further surgery will be required. Your surgeon may discuss implanting a secondary device to reduce the transmission of forces at the time of the initial surgery &lquo;topping off&rquo;.
Failure of fusion
This is the biggest concern following fusion surgery. As stated above the fusion process may fail. Factors which may affect the fusion process are smoking and osteoporosis. If fusion fails to occur, then the metalwork may loosen or break. Back pain can then be increased to greater than the pre-operative level. A revision procedure may then be required.
It is thought that the trauma of surgery may induce scarring around the nerve root following decompression. This can cause the nerve root to become stuck down and cause pain. This is a very difficult problem to treat and may necessitate steroid injections or rarely further surgery to release the nerve.
Adjacent level disease
Making one level in the spine rigid results in the transmission of forces to the levels on either side. This can instigate or hasten the degeneration of the discs or facet joints above and below the fusion. There is no consensus of opinion as to the incidence of this complication or its clinical significance i.e. degeneration does not necessarily mean that pain will be experienced or that further surgery will be required. Your surgeon may discuss implanting a secondary device to reduce the transmission of forces at the time of the initial surgery &lquo;topping off&rquo;.
Failure of fusion
This is the biggest concern following fusion surgery. As stated above the fusion process may fail. Factors which may affect the fusion process are smoking and osteoporosis. If fusion fails to occur, then the metalwork may loosen or break. Back pain can then be increased to greater than the pre-operative level. A revision procedure may then be required.
QUESTIONS
This document is intended to cover the most significant risks and commonly asked questions. If you have any further questions then please contact your surgeon's secretary
