Spinal Fusion Surgery
What is Spinal Fusion?
Spinal fusion is a procedure performed when the spinal column becomes dangerously unstable and requires stabilization. The spinal column consists of numerous vertebrae that support the body and protect the spinal cord and nerve roots. There are three main sections of the spine including the cervical (neck region), thoracic (mid-back) and lumbar (low back). Spinal instability occurs after degenerative changes, injury, or tumors affect the structural integrity of the bony spinal column.
The main concern of an unstable spine is the tendency for the bony elements to compress the delicate nerve tissue. While an intact vertebral column protects the delicate neural elements such as the spinal cord and nerve roots, an unstable vertebral column threatens irreversible neuronal damage. Dr. John Lipani at Princeton Neurological Surgery performs spinal fusions at his New Jersey locations.
Candidates for Spinal Fusion Surgery
Choosing the appropriate candidate for spinal fusion is paramount to achieving the best results. Many patients who are appropriate candidates for spinal fusion have failed conservative treatments or have worsened clinically. Patients requiring spinal fusion often include those:
- Who’ve suffered trauma to the spinal column
- With spondylolisthesis or spondylosis
- With large disc herniations causing spinal cord compression (especially in the cervical or thoracic spinal column)
- That has significant spinal canal stenosis that may require destabilizing decompressive surgery.
Qualified surgeons are responsible for identifying patients who are appropriate candidates for spinal fusion and must decide whether it should be performed urgently. Sustained compression of the neural elements can result in permanent neurologic dysfunction and lead to numbness, weakness, loss of bodily functions and/or paralysis. Therefore, it may be a serious mistake to avoid or delay spinal fusion in certain cases. Although failed fusions can occur, they are much less likely in the hands of an experienced and well-trained spinal surgeon.
What Our Patients Say
“I had a spinal fusion L4-S1 with Dr. Lipani about 6 months ago…If you are concerned about pursuing surgical treatment for your spine problem I highly recommend that you talk to Dr. Lipani and his extremely experienced and talented nurse Kathy. The individual attention and concern they show to their patients is remarkable and reassuring. I highly recommend them for their skill, compassion and dedication to their patients. Thank you so much Dr. Lipani and Kathy! I feel great!”
Spinal Fusion Procedure
Dr. Lipani employs various techniques for spinal fusion, depending on the location of the vertebrae and the reason for the fusion. He may approach the spine from the front in anterior spinal fusion or from the back in posterior spinal fusion. In anterior fusion, Dr. Lipani uses a plate is to fasten the two vertebrae together. In posterior fusion, rods and screws are used.
The patient is under general anesthesia for this surgery. Regardless of the method, this is the usual procedure.
- Making the incision — To gain access to the vertebrae, Dr. Lipani makes an incision either in the neck or back directly over the spine (posterior), on either side of your spine, or in your abdomen or throat (anterior). He will move any necessary muscle and tissue to access the spine.
- Disc removal and graft placement — Now the disc is removed between the two vertebrae to be fused. Often this disc has herniated and is pushing on the adjacent spinal cord or nerve roots. Bone graft material replaces the disc. This material will grow and fuse the two vertebrae into one. The graft may come from a bone bank, your body (usually your pelvis), or synthetic.
- Fusion — The bone graft material will fuse the two vertebrae together permanently, but to provide support to keep the vertebrae together while the graft grows, Dr. Lipani binds the two vertebrae to each other with either a plate and four screws or with a pair of vertical metal rods and screws. This completely stabilizes the spine to allow the graft to grow effectively.
What Conditions Can Spinal Fusion Treat?
Spinal fusion is performed to return stability to a portion of the spine. Dr. Lipani usually performs a fusion in the cervical spine or the lumbar spine. Spinal instability can allow the bony elements of the spine to press on the spinal cord or the nerve roots causing chronic pain and potentially permanent nerve damage and loss of function.
These are some typical reasons Dr. Lipani could recommend fusion surgery:
- Broken vertebrae — Not all broken or cracked vertebrae would automatically require fusion, as some can heal. But if broken vertebrae are creating instability, fusion may be necessary.
- Herniated disc — When a disc herniates and needs to be removed, fusion may be necessary to stabilize the spine.
- Spinal weakness or instability — When a person suffers from either osteoporosis or osteoarthritis, there can be excessive motion between two vertebrae. Fusion eliminates this.
- Spondylolisthesis — In this condition, one vertebra slips forward and onto the vertebra below it. If this has caused nerve compression and numbness in the extremity served by the nerve, fusion may be necessary.
- Spinal deformities — Fusion can help correct scoliosis (curvature of the spine) or kyphosis (abnormal rounding of the upper spine).
Importance of a Spinal Fusion
There is a lot of fear and apprehension associated with undergoing spinal fusion. However, when clinically indicated, spinal fusion can protect neurologic function and restore structural stability with the ultimate goal of restoring a healthy quality of life. Significant degenerative changes affecting the cervical spinal column, for example, can eventually lead to paralysis from unrelenting compression of the spinal cord. Similarly, a large disc herniation in the lumbar spine can result in changes in bowel and bladder function in addition to numbness and weakness in the lower extremities. It’s extremely important to emphasize that neuronal compression left unchecked can lead to irreversible loss of function. It is equally important to remember that spinal fusion should only be performed by surgeons trained in protecting the integrity of the nervous system.
Who Should Perform Spinal Fusion?
Spinal fusion should only be performed by board-certified neurosurgeons or orthopedic surgeons with highly specialized training in complex spinal surgery. Without adequate training, surgical outcomes may be significantly compromised. For example, the surgeon must have significant operative training and experience with the spinal cord and nerve roots and should also be able to respond appropriately if these delicate neural structures are injured, either before, during, or after surgery. In addition, advanced clinical expertise in complex spinal reconstruction is also necessary to perform successful spinal fusion constructs. Spinal fusion procedures should not be performed by pain management doctors or any surgeon without extensive formal training and clinical experience using complex spinal instrumentation and performing complex spinal fusions. To learn about choosing between a neurosurgeon and an orthopedic surgeon for spinal surgery, click here.
Choose Dr. John Lipani
Dr. John Lipani is a trusted neurosurgeon with years of knowledge and experience performing complex and minimally invasive spinal surgery. Dr. Lipani spent several years at the Delaware Valley Regional Spinal Cord Injury Center at Thomas Jefferson University Hospital in Philadelphia. It is one of the nation’s 16 centers of excellence for spinal disorders. Dr. Lipani participated in the combined neurosurgical and orthopedic spine fellowship program. He also completed a fellowship at NYU Medical Center in neurosurgery with a focus on complex spinal surgery, which remains a significant part of his current practice.
Goals of Spinal Fusion
The two main goals of spinal fusion are:
- To decompress and preserve the function of the spinal cord and nerve roots
- To restore the structural integrity of the spinal column
Compression of the spinal cord and nerve roots may occur from a degenerative spinal column, a compressing tumor, or other injuries. Chronic degenerative changes affect the cervical and lumbar spinal column more often than the thoracic segment. The spinal column may become unstable prior to surgery or may become unstable after the neural elements have been decompressed during surgery. In other words, sometimes it is necessary to destabilize the spinal column in an effort to adequately free the nervous tissue from bony compression during spinal surgery. Therefore, spinal fusion candidates may not necessarily have unstable spinal columns prior to surgery.
How Long Will it Take to Recover from Fusion Surgery?
After your fusion surgery with Dr. Lipani, you’ll be in the hospital for usually two to three days. You’ll have some pain and discomfort, but this is manageable with pain medications. We’ll take spinal x-rays before discharge, just to make sure everything looks good. Then we’ll send you home. Your stitches will come out in about 10 days. From there, you’ll have follow-up appointments in about 4-6 weeks, 6 months, one year and two years.
Your recovery will take some commitment and work on your part. It can take up to 6 months to a year for your back to fully heal. Physical therapy is important and ongoing. For the first 6 months, you’ll need to avoid twisting, bending, and any heavy lifting (that means anything over a gallon of milk).
What are the Risks of Spinal Fusion Surgery?
Spinal fusion is generally a safe procedure. There, of course, are the usual risks of any surgery: infection, poor wound healing, excessive bleeding, blood clots, and nerve damage.
Beyond the immediate risks, fusing two or more vertebrae together changes how your spine works and handles loads. Because two vertebrae are now one, the stress usually handled by that area of the spine will shift to adjacent areas of the spine. This added stress can accelerate wear and tear in the vertebral joints on either side of the fusion.