(Spinal Arthrodesis; Vertebral Interbody Fusion; Posterior Lumbar Interbody Fusion; Transforaminal Lumbar Interbody Fusion; Anterior Lumbar Interbody Fusion; Posterolateral Lumbar Fusion )
by Laurie LaRusso, MS, ELS
A spinal fusion is a surgery to weld together 2 or more vertebrae. Vertebrae are the bones that make up the spine.
There are several different types of spinal fusions based on factors, such as the part of the spine involved, placement of the incisions, and the parts of the vertebra that are initially fused. All fusion surgeries include the use of a graft that is made of bone material. It stimulates healing and encourages the 2 bones to heal together into one solid bone. The graft may be a piece of bone from the hip, a piece of bone from a cadaver, or artificial bone material.
Reasons for Procedure
Spinal nerves exit the spine between the vertebrae. Damage to the vertebra and the disc that sits between them can put extra pressure on these nerves. The irritated nerves can cause pain and weakness in the areas of the body affected by the nerve. Spinal fusion may be considered if all other methods of treatment (medication, rest, physical therapy) have not been able to relieve pain or disability. A spinal fusion removes damaged tissue and locks the 2 vertebra in place to prevent irritation of the spinal nerve between the vertebrae.
Medical conditions that may lead to spinal fusion include:
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:
What to Expect
Prior to Procedure
Your doctor may do the following:
Before your surgery:
Description of Procedure
Spinal fusion can be done by open surgery or using a minimally invasive technique. The exact steps will depend on the type of spinal fusion that is being done. Some examples include:
Interbody fusion uses the surfaces in between the vertebra for fusion. The disc in between the vertebrae is either partially or completely removed. A cage (spacer) will be placed between the vertebra where the disc was removed. The cage may be made of plastic or metal. It may also contain graft material that will help the bones heal and fuse together. Metal screws and plates may then be placed on the outside of the vertebra to help stabilize the bones. There are 3 types of interbody fusion based on the approach to the area:
Another option called posterolateral fusion starts the fusion on the outer surface of the vertebra. An incision is made in the back. The muscles are pushed aside to access the vertebra. Damaged bone and structures may be removed to relieve pressure on spinal nerves. A graft material will be placed along the outside of the vertebra to encourage bone healing and growth, and stimulate the fusion. Titanium screws and rods may also be used to help stabilize the bones while they heal. This option may also be used to treat scoliosis.
With all surgeries, the incision will be closed with stitches or staples.
How Long Will It Take?
4-6 hours (sometimes longer)
How Much Will It Hurt?
Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.
Average Hospital Stay
3-4 days (sometimes less, sometimes more, depending on age, overall health, and extent of surgery)
At the Hospital
You may receive the following care at the hospital:
During your stay, the hospital staff will take steps to reduce your chance of infection such as:
There are also steps you can take to reduce your chances of infection such as:
It will take several months to a year for the bones to fully fuse, but symptoms may improve earlier. During recovery, it is important to follow posture and activity recommendation to help the bones stay in proper alignment.
Certain activities like heavy lifting, twisting, or strenuous activities will need to be avoided during recovery. Assistance with daily activities may be needed. Physical and occupational therapists can demonstrate how to do certain activities without placing stress on the back. Some limitations may need to be followed even after recovery. The fusion will limit some flexibility of the spine but the difference should not make a significant impact on daily activities.
Time off from work ranges from 4-6 weeks to 4-6 months. The length of time depends on your age, overall health, and the physical demands of your job.
Rehabilitation may be done in a hospital or at an outpatient clinic. The program will likely include:
Following your rehabilitation program will speed your recovery and reduce discomfort.
Call Your Doctor
It is important to monitor your recovery. Alert your doctor to any problems. If any of the following occur, call your doctor:
If you think you have an emergency, call for emergency medical services right away.
Know Your Back—North American Spine Society
Ortho Info—American Academy of Orthopaedic Surgeons
Canadian Orthopaedic Association
When it Hurts to Move—Canadian Orthopaedic Foundation
Anterior lumbar interbody fusion. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: https://orthoinfo.org/en/treatment/anterior-lumbar-interbody-fusion. Updated January 2016. Accessed December 18, 2017.
Chronic low back pain. EBSCO DynaMed Plus website. Available at: http://www.dynamed... . Updated June 30, 2017. Accessed December 18, 2017.
Kim CW, Siemionow K, Anderson DG, Phillips FM. The current state of minimally invasive spine surgery. J Bone Joint Surg Am. 2011;93(6):582-596.
Posteriolateral fusion. Laser Spine Institute website. Available at: https://www.laserspineinstitute.com/back_problems/back_surgery/types/posterolateral. Accessed December 18, 2017.
Posterior lumbar interbody fusion and transforaminal lumbar interbody fusion. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: https://orthoinfo.aaos.org/en/treatment/spinal-fusion-plif-tlif. Updated June 2010. Accessed December 18, 2017.
Spinal fusion. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: https://orthoinfo.aaos.org/en/treatment/spinal-fusion. Updated June 2010. Accessed December 18, 2017.
Spine surgery: Lumbar interbody fusion. Hospital for Special Surgery website. Available at: https://www.hss.edu/conditions_spine-surgery-lumbar-interbody-fusion.asp#.VJMAvsAKA. Updated May 9, 2011. Accessed December 18, 2017.
Last reviewed November 2018 by EBSCO Medical Review Board Michael Woods, MD, FAAP
Last Updated: 12/20/2014
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