Fusion Back Surgery

Bone grafts are used in spinal fusions

Back Surgery fusion is performed in order to stabilize the spine and prevent painful motion at a particular vertebral segment, or multiple vertebral levels.  Back Surgery is usually most successful when at a single level, although multiple-level fusion (of six or more levels) has been carried out successfully in some patients.  The surgery involves the use of a bone graft which aims to fuse the vertebra together by stimulating new bone growth.  Conditions such as degenerative disc disease, isthmic, degenerative, or postlaminectomy spondylolisthesis, or scoliosis may lead to a recommendation for spinal fusion.  Similarly, any weakness of the spine as a result of tumor growth, infection, trauma, fractures, or previous surgery (such as laminectomy) may lead a patient to undergo spinal fusion surgery.

Bone Graft

The bone graft used during the procedure may be taken from the patient themselves during the operation and is usually source from the iliac crest (hip bone).  This is called an autograft, but where this is not possible or desirable an allograft may be used instead where cadaverous bone is used, or a manufactured synthetic graft material implanted instead.  A number of types of spinal fusion are carried out including posterolateral gutter fusion (posterior approach), posterior lumbar interbody fusion (also known as TILF/PLIF), anterior lumbar interbody fusion (from the front), and anterior/posterior spinal fusion.

Multiple Level Fusion

Multiple level spinal fusion is not commonly conducted as success rates diminish with each extra vertebrae involved.  Fusion across three or more levels is usually applied only in cases of scoliosis or lumbar deformity and not for back pain alone.  Carrying out fusion on more levels restricts movement and the pain associated with it but can also put extra pressure on the remaining vertebrae.  This can cause further pain and, occasionally, fracture to occur in the remaining joints.

Some of the Risks

Other risks of spinal fusion include a failure to form a union, failure to relieve pain (whether fusion occurs or not), further spinal degeneration, infection, blood loss, hardware failure, and problems with anaesthesia.  Nerve trauma can also occur leading to pain, paraesthesia, numbness, weakness, and, in rare cases, paralysis.  Those who smoke are at a higher risk of experiencing failed back surgery syndrome, particular in terms of spinal fusion as the nicotine (and other factors) in cigarettes inhibits bone growth and healthy fusion occurring.  Patients who are obese or in poor health generally are also less likely to have a successful surgical outcome.

Spinal fusion is a major back surgery and lasts several hours.  The trauma that the body experiences takes a significant amount of time to recover from and patients should expect to be away from work for many weeks.  Minimally invasive spinal fusion may be a possibility for some patients having back surgery at a single level.  This type of surgery carries with it less risk of muscle damage and pain, lower blood loss, and a shorter recovery time in most cases.

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