Spinal fusion can be an effective way to relieve back pain due to spinal problems, but is not without risks.
Results of spinal fusion surgery vary depending on the reason for the surgery and the type of surgery. Doctors can’t really be sure which patients are most likely to benefit from spinal surgery, but they think that psychological factors play a role.
Unless your symptoms are severe, or you have pain, tingling or numbness in your arms and legs, it’s usually safe to delay surgery until you’ve explored other treatment options.
Overall, only about 62% of people are happy with the result of their spinal fusion surgery. People who are satisfied may not be entirely pain free, but they have a decreased need for painkillers. Non-smokers achieve better results compared to smokers.
One of the drawbacks of this surgery is that fusing the lumbar spine will most likely reduce your ability to bend over. If your cervical spine is fused, you may have trouble turning your head to the side which can affect your ability to drive. Also, other levels of your spine above or below the one operated on may need similar surgery in the future. Disc replacement — as an alternative to fusion — may reduce that risk, but this is yet to be proven.
If you have non-specific low back pain, it’s possible this surgery won’t improve things. Having intense rehabilitation instead, plus cognitive behavioural therapy may well be just as effective as surgery. When surgery doesn’t relieve the pain, your surgeon may recommend having a second surgery. Some people don’t get relief despite repeated surgeries. It’s known as failed back surgery syndrome and is complex to treat.
As with any medical procedure there are some potential risks. The chance of complications occurring depends on the exact type of procedure that you’re having and other factors including your general health and if you’re a smoker, whether you comply with your surgeon’s requirement to stop smoking for the surgery.
The main risks with spinal fusion surgery are:
- tear of the dura (the protective sheath around the spinal nerves) which can cause a leak of spinal fluid (3% to 14%)
- failure of the bones to fuse properly (5% to 14%)
- nerve injury (0.5% to 2.8%)
- pulmonary embolus (2. % to 5%).
- infection (2% to 5%)
- deep vein thrombosis (1.6% to 5%)
- post-operative bleeding (1% to 15%)
Additional risks with cervical spinal fusion surgery are:
- temporary difficulty swallowing
- temporary loss of voice.
Additional risks with lumbar spinal fusion surgery are:
- urinary retention
- sexual dysfunction due to nerve damage (less than 1%)
- injury to the spinal cord (causing paralysis)
- injury to the small or large intestines
- injury to the ureters (tubes that bring urine from your kidneys to your bladder)
- temporary slowing of bowel movements
Long-term complications include:
- persistent pain at the site of the donor bone graft
- problems due to altered spine mechanics
- degenerative changes in adjacent vertebrae
- wearing out or failure of the of the metal parts
- lack of pain relief (or worsening of symptoms).
Ask your surgeon about the results and risks associated with your procedure. Also ask about their own rates of patient satisfaction and the rate of complications following the procedures they’ve performed.