Spinal Fusion Surgery

By Sally Ann Quirke, Chartered Physiotherapist | Filed under: Back Surgery

Published: 06 July 2018

Spinal fusion surgery is a technique used to combine two or more vertebrae in the spine. One example of when it is needed is where excess movement of one vertebra relative to another causes severe pain and/or neurological symptoms. In these cases, the vertebrae are ‘fused’ together to prevent them moving. There are different methods used in this surgery, a common ones being taking a metal implant or bone graft from another part of the body (pelvic bone) and using them as bridges to facilitate bone growth that will fuse the vertebrae together.

Spinal Fusion to relieve back pain

Spinal fusion surgery should be considered as a last resort for particular back pain conditions - it is not a treatment option that should be undertaken lightly! However there are occasional situations where early or urgent intervention is needed. Let me give you an example:

Some weeks ago a 35 year-old woman came to me with severe neck pain and neurological symptoms. She had 9/10 central lower neck pain (see severe neck pain), with pins and needles and numbness down her right arm. It had been present for one week.

On assessment, she had the signs and symptoms of a severe disc prolapsed at C5/6 with associated nerve and neurological findings. Though we referred her immediately through her doctor for a surgical review, it took three weeks for this lady to be assessed for by an orthopaedic surgeon. By the time she got an appointment her symptoms had worsened significantly.

Emergency surgery was then performed which involved both the C 5/6 disc being removed as well as a fusion of both the C5 and C6 vertebra. She was then put into a brace for six weeks to allow the vertebra to fuse together. The good news is that her pain, numbness and pins and needles have gone.

It turned out that However, without surgery no resolution of her condition was possible. This is a classical example of why early intervention, when indicated, is better. If this lady had been given an earlier surgical review, the surgery required may not have been so big. Her post surgery recovery includes physiotherapy and exercises to prevent long term weakness in her right arm that may potentially result from the long term nerve impingement of the nerve that was present. Thankfully, she is diligently following her post operative treatment program. I find that the patients who follow through with their spinal surgery recovery programs do better in the long term than those who are ‘less attentive’! See more about recovery from herniated disc surgery here)

This example is where of spinal fusion had to be used in the treatment of herniated disc in the neck. Other conditions commonly requiring spinal fusion involve:

• Degenerative disc disease: Where the discs are worn away and thin.
• Vertebral fracture: Where a bone in your neck is cracked and unstable.
• Scoliosis: Where there is a deviation in your spine and instability results between two or more bones (more articles on Scoliosis here).
• Scheuermanns disease: Where a degenerative process is resulting between two or more bones, and they are growing at incorrect angles to each other.
• Spondylolisthesis: Where one vertebra is slipping forward relative to another. (read more on Sponydlolisthesis here)
• Spondylosis: Where degenerative osteoarthritis results in the nerves being compressed extremely.
• Other degenerative conditions of the spine: Where severe osteoarthritis or rheumatoid arthritis results in instability of two or more vertebrae.

Spinal Fusion Surgery - Summary

In summary - spinal fusion is a very effective treatment in many conditions involving joint instability but it should be considered as a treatment of last resort, once good physiotherapy and manual techniques have been tried.

However, never ignore neurological symptoms including pain, pins and needles, weakness and numbness. If you have these, then seek a good medical and physiotherapy opinion to advise you on the appropriate treatments required in the management of your neck and arm pain. If they think you need surgery, they will send you for an assessment with a surgeon.

If you have to go for spinal fusion surgery, then listen closely and work with the team around you. Discuss with them what you can do to prepare for surgery that will help the operation and recover. Following surgery, physiotherapy is essential in the management of this condition and if you fully complete the exercise programs you have been given, you increase your chances of a fuller and longer lasting recovery. Do not think time will resolve your problem.