What is lumbar spinal fusion?

Spinal fusion is surgery that joins, or fuses, two or more vertebrae together. The joints will no longer be able to move. The surgery is also called arthrodesis.

Most of the time, bone from your pelvic bone or from a bone bank is used. Or sometimes human-made bone is used. This bone is used to make a "bridge" between the vertebrae to be joined. Metal rods, wires, or screws are often attached to the vertebrae. This will hold them together until new bone grows between them.

Spinal fusion surgery usually takes a few hours. It involves making a cut in your back, belly, or side. The cuts, called incisions, leave scars that fade with time.

You can expect your back to feel stiff and sore after surgery. You will be given pain medicine. You will probably get up and walk at the hospital. You will have a short hospital stay.

It may take 4 to 6 weeks to get back to doing simple activities, such as light housework or office work.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover.
• Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation. Walking may also decrease your muscle soreness after surgery.
• If advised by your doctor, you may need to avoid lifting anything that would cause excessive strain on your back. This may include a child, heavy grocery bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, or a vacuum cleaner.
• Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or aerobic exercise, until your doctor says it is okay.
• Do not drive for 2 to 4 weeks after your surgery or until your doctor says it is okay.
• Avoid riding in a car for more than 30 minutes at a time for 2 to 4 weeks after surgery. If you must ride in a car for a longer distance, stop often to walk and stretch your legs.
• Try to change your position about every 30 minutes while sitting or standing. This will help decrease your back pain while you are healing.
• You will probably need to take at least 4 to 6 weeks off from work. It depends on the type of work you do and how you feel.
• You may have sex as soon as you feel able, but avoid positions that put stress on your back or cause pain.

Diet

• You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
• Drink plenty of fluids (unless your doctor tells you not to).
• You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Medicines

• Be safe with medicines. Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.

Incision care

• You will be given specific instructions about how to care for the cuts (incisions) the doctor made. The instructions will depend on the type of materials used to close the cut.

Exercise

• Do back exercises as instructed by your doctor.
• Your doctor may advise you to work with a physical therapist to improve the strength and flexibility of your back.

Other instructions

• To reduce stiffness and help sore muscles, use a warm water bottle, a heating pad set on low, or a warm cloth on your back. Do not put heat right over the incision. Do not go to sleep with a heating pad on your skin.

Spinal fusion is often needed to keep the spine stable after injury, infection, or a tumor.

In general, studies don't show a clear difference between spinal fusion and structured rehabilitation for treating chronic low back pain from degenerative changes in the spine. This type of rehabilitation can include exercise, education, and cognitive-behavioral therapy.

As you decide about having spinal fusion, talk with your doctor about the benefits and risks.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• You may need to shower or bathe with a special soap the night before and the morning of your surgery. The soap contains chlorhexidine. It reduces the amount of bacteria on your skin that could cause an infection after surgery.
• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

The risks of this surgery depend on your age and overall health, what you're having the surgery for, and the type of procedure you have.

Risks include:

• Pain at the bone graft site.
• Failure of the fusion, breakage of metal implants, or both.
• Blood clots that may also lead to pulmonary embolism.
• Nerve injury.
• Graft rejection.
• Infection.
• Excessive bleeding.
• Risks of anesthesia.

After surgery, you will have a short hospital stay.

Bed rest usually isn't needed while you recover at home.

Your doctor may recommend that you wear a back brace while you recover.

Rehabilitation can take a long time. It includes walking, riding a stationary bike, swimming, and similar activities.

After surgery, you can expect your back to feel stiff and sore. You may have trouble sitting or standing in one position for very long. It may take 4 to 6 weeks to get back to doing simple activities, such as light housework. It may take 6 months to a year for your back to get better completely.

You may need to wear a back brace while your back heals. And your doctor may have you go to physical therapy.

If your job doesn't require physical labor, you will probably be able to go back to work after 4 to 6 weeks. If your job involves light physical labor, it may take 3 to 6 months. If your job involves heavy labor, you will probably need to find work doing something less strenuous. There are training programs that can help.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• The area for surgery is often marked to make sure there are no errors.
• You will be kept comfortable and safe by your anesthesia provider. You will be asleep during the surgery.
• Surgery will take a few hours.

Spinal fusion may be done by itself or along with surgery to remove bone and tissue that are narrowing the spinal canal and squeezing the spinal cord and/or the spinal nerves.

It may be done as a follow-up after surgery that was done to treat problems such as spinal stenosis, herniated discs, injuries, infection, and tumors.