Spinal Fusion

Spinal fusion permanently joins two or more vertebrae to eliminate motion between them. Bone graft material is placed between the vertebrae, and hardware (screws, rods, plates) holds them in place while they fuse. Over 450,000 spinal fusions are performed annually in the US.

Spinal fusion treats degenerative disc disease, spondylolisthesis, spinal stenosis, scoliosis, vertebral fractures, spinal tumors, and spinal instability. It is typically considered after 6+ months of conservative treatment has failed.

Pre-operative testing includes MRI, CT scan, X-rays, and blood work. Stop smoking at least 4-6 weeks before surgery (smoking significantly impairs bone healing). Optimize nutrition and blood sugar control. Stop blood thinners as directed.

Under general anesthesia, the surgeon accesses the spine through an anterior (front), posterior (back), or lateral (side) approach. Damaged disc material is removed, bone graft is placed, and hardware is implanted. Minimally invasive techniques use smaller incisions. Surgery takes 2-6 hours.

Hospital stay is 2-5 days. A brace may be worn for 6-12 weeks. Avoid bending, lifting, and twisting (BLT restrictions). Physical therapy begins 4-6 weeks after surgery. Full bone fusion takes 3-6 months. Maximum improvement is seen at 12-18 months.

Risks include hardware failure, non-union (pseudarthrosis, 5-15%), infection, nerve damage, blood clots, adjacent segment disease (degeneration above/below fusion), and continued pain. Smoking dramatically increases the risk of non-union.

Alternatives include physical therapy, epidural steroid injections, nerve blocks, anti-inflammatory medications, chiropractic care, disc replacement (for single-level disc disease), and pain management programs.

Covered by insurance with prior authorization and documentation of failed conservative treatments. Extensive documentation is often required. Some insurers require a second surgical opinion.