Spinal fusion surgery is performed to relieve pain caused by a range of spine problems including degenerated discs, foraminal stenoses, spondylolistheses, fractures and scoliosis.
Cervical (neck) spinal fusion surgery
Your surgeon makes a small incision in the front or back of your neck. After retracting/dissecting muscles, they look through an operating microscope or optical loupes and remove the damaged disc then replace it with a bone graft. Metal plates and pins help to hold the bones together until they fuse. Some devices have built-in fixation. Fusion can also be performed from the back — known as a lateral mass fusion. Sometimes disc replacement may also be needed.
Lumbar (lower back) spinal fusion surgery
There are several different ways of performing lumbar spinal fusion. Depending on the problem with your spine, and your surgeon’s skills, it may be done through an incision in your back, abdomen or side.
After pulling back the muscles and/or organs, your surgeon looks through an operating microscope and removes the damaged disc, replacing it with a bone graft. One or more lamina (bones at the back of your spine) may also be removed if they’re putting pressure on your spinal nerves.
The bone graft may come from your hip or from a donor. Alternatively, synthetic bone graft material may be used. Some surgeons use a substance called bone morphogenic protein (BMP) to stimulate the growth of new bone. However, BMP has not been shown to provide a superior result, and it adds significantly to the cost. It’s also believed to be potentially carcinogenic.
Your surgeon may use a metal cage with titanium screws and rods or interfixed screws to help to hold the bones together until they fuse.
Minimally-invasive lumbar spinal fusion surgery
This type of spinal surgery is performed through small incisions in your back. It’s also known as transforaminal lumbar interbody fusion (TLIF). It’s usually performed using a microscope. Some technologically-advanced hospitals use computer-assisted navigation and intra-operative CT scanning.
Minimally-invasive spinal fusion can reduce the risk of post-operative infection and blood loss, as well as reducing your hospital stay and recovery time. If you prefer this option, you need to search out a surgeon who is trained in minimally-invasive spinal surgery techniques.
If the surgeon encounters problems during minimally-invasive surgery, they may need to convert to open surgery.
Fusion of multiple lumbar vertebrae
If you have more than 1 degenerated disc, or a problem such as scoliosis, you may benefit from fusion of more than 1 vertebra. The techniques are similar, but the surgery is more complex and takes longer to perform. Fusing multiple vertebrae can also significantly limit the mobility of your spine.
If you have problems with 2 adjoining discs, your surgeon may recommend hybrid surgery where 1 disc is replaced with an artificial disc and the one next to it is fused. This is usually approached from the front or occasionally, the side.