Spinal fusion

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Spinal fusion is the surgical stiffening of the spine. It is used, among other things, for certain forms of back pain and unstable changes in the spine. The result of the operation is, of course, a loss of movement in the stiffened vertebral joint. Read everything you need to know about spinal fusion, when it is performed and how it works.

What is a spinal fusion?

Spinal fusion is an operation to stiffen the spine. It is necessary when there is significant instability of the spine. Since the spinal fusion leads to a significant and irreversible loss of movement in the stiffened joint, treatment with conservative measures such as physiotherapy is attempted first. Only if the patient's symptoms cannot be sufficiently improved in this way does the doctor recommend spinal stiffening.

Depending on where the instability exists, the spinal fusion is carried out on different levels of the spine: For example, the doctor can stiffen the joints of individual lumbar vertebrae, but also joints of the thoracic or cervical spine.

In spinal fusion, access can be from the front, i.e. ventral, as well as from the rear (dorsal spondylodesis).

When is a spinal fusion performed?

An instability of the spine arises, for example, from wear of the intervertebral discs, vertebral body fractures and tumors, vertebral slippage or osteoarthritis of the vertebral joints. In some cases, patients with scoliosis can also benefit from spinal stiffening.

When is it not allowed to perform a spinal fusion?

Some pre-existing conditions do not allow spinal fusion, for example severe osteoporosis or cancer with tumor foci in several areas of the spine. The procedure is also not recommended if the patient has had radiation therapy to the spine in the past.

What do you do with a spinal fusion?

The patient is usually given general anesthesia for the spinal fusion. He is then placed on the prone position on the operating table. Then the surgeon uses a scalpel or an electric knife to cut through the skin and the fatty tissue at the site of the planned stiffening (lumbar spine = living spine, thoracic spine = thoracic spine, etc.). If he has pushed the back muscles to the side, he gets to the spinous processes of the vertebral bodies. The doctor now works on the cartilage surfaces of the vertebral joints with bone forceps. Often he also has to remove parts of the bony vertebral bodies, for example with a burr or a small chisel. Sometimes he also has to remove the entire vertebral body. In addition, the surgeon removes the elastic intervertebral disc and replaces it with a rigid hollow body, which is either filled with the body's own bone tissue (e.g. from the iliac crest) or bone substitute material. Now the doctor will stiffen the vertebrae by implanting special screws or plates for stabilization.

Before the final wound closure, the surgeon places a drainage tube in the operating area through which the blood and wound fluid can drain. If he has sewn up the wound, he covers it with a sterile adhesive plaster. The patient is then taken to the recovery room and can recover from the anesthesia there.

In some cases, spinal stiffening can be carried out more gently with a minimally invasive operation.

What are the risks of a spinal fusion?

Before the procedure, the doctor must educate the patient about the possible risks of spinal fusion. This includes:

Injury to nerves, possibly with permanent damage
Paraplegia caused by damage to the spinal cord
Loosening, slipping and breaking of screws, plates or other implanted stabilizers
Injury to organs in the abdomen (only with front access)
impaired bone healing with formation of a false joint (pseudarthrosis)
Breaches into neighboring vertebrae
persistent back pain

In addition, there are general surgical complications such as bleeding, infections, scarring and wound healing disorders.

What do I have to consider after a spinal fusion?

You can usually get up the day after the operation. However, this should take place under the supervision of a physiotherapist, at least the first time. Under his guidance, you must then begin careful movement exercises as early as possible after the procedure in order to strengthen the back muscles and the ligaments. You should avoid jerky movements, twisting movements and a curvature of the back to the hump. You will receive a support corset or corset for additional stabilization.

Due to the pain, many patients take it easy after an operation and also breathe in a relieved position. This inadequate ventilation of the lungs, however, promotes pneumonia. You should therefore start breathing exercises after the spinal fusion.

Wound hygiene after spinal fusion

The doctor removes the inserted drainage as soon as large amounts of blood or wound secretions no longer leak out. This usually happens on the first or second day after the spinal fusion. You should avoid any contamination until the wound has healed. The plasters should be changed regularly. Special shower plasters cover the wound so that it is watertight. Use them afterwards until the surgical wound of the spinal fusion has healed.

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