Spine surgery is used for chronic spinal conditions that aren’t improved by non-invasive treatments. In many types of spine surgery, namely decompression, spinal fusion is used to stabilize the spine.
While fusion can often effectively provide stability, correct spinal deformities, and relieve pain, it can seriously inhibit the range of motion in the spine. This, along with a lengthy recovery, has created a demand for fusion alternatives.
Let’s compare fusion and non-fusion spinal surgery to learn more about the treatments available for chronic back pain patients.
Understanding Spinal Fusion
Fusion is a type of spinal surgery that permanently binds two vertebrae (the bones that make up the spine). In the weeks and months after spinal fusion, the fused vertebrae will become a single bone.
The goal of spinal fusion is to stabilize the spine, alleviate pain, and/or rectify a spinal deformity.
What Happens During Spinal Fusion?
Spinal fusion may be performed along with a range of different spinal procedures. It’s commonly done along with spinal decompression procedures, such as laminectomy. During decompression, the surgeon removes a portion of tissue from the spine to relieve pressure on the spinal nerves.
During spinal fusion, you’ll be under general anesthesia, and your surgeon will likely carry out the following steps:
- The surgeon will make an incision to access the spine. The incision may be located in the back, abdomen, or side of the body.
- The surgeon will prepare the bone graft. The bone graft may be an allograft or taken from your body.
- The surgeon will place the bone graft in between the vertebrae and may use a cage, plates, or rods for stability.
What Conditions Require Spinal Fusion?
Conditions that may be improved with fusion include:
- Degenerative disc disease
Degenerative disc disease is a term used to describe back pain symptoms that result from age-related spinal deterioration. Over time, wear and tear on the spine can wear down the discs that cushion the vertebrae. Spinal discs also naturally dry out with age, making them more susceptible to damage.
The symptoms of degenerative disc disease generally include:
- Back pain that worsens while sitting, lifting, bending, or twisting and improves while walking, lying down, or changing position
- Numbness, weakness, and/or tingling in the extremities
- Pain that comes and goes, with some severe pain flare-ups
- Spinal stenosis
Spinal stenosis is a condition that occurs when the spaces inside of the spine tighten. As the spinal canal narrows, nerves and the spinal cord can get compressed.
Bone spurs from osteoarthritis, the thickening of ligaments in the spine, slipped discs, and vertebral fractures can contribute to spinal stenosis. Patients with this condition typically experience back pain and neurological symptoms.
- Herniated disc
When an intervertebral disc becomes damaged, whether due to an injury or gradual wear and tear, the interior of the disc can press out through a crack in the disc’s exterior. When this occurs, the damaged disc can push on nearby nerves and cause pain.
A herniated disc is a relatively common injury and can typically be managed without surgery. However, in severe cases, patients may need surgical decompression and fusion.
Scoliosis is a condition that makes the spine curve abnormally. This condition can be idiopathic, meaning that it has no known cause, or result from spinal deterioration over time. Scoliosis can cause nerve compression and require surgery.
Spinal instability can make one of the spinal bones slip forward and settle on the vertebra beneath it. The misplaced bone can put pressure on spinal nerves, leading to back pain, muscle spasms, difficulty standing, and neurological symptoms. This condition is called spondylolisthesis.
Some cases of spondylolisthesis require surgical decompression and spinal fusion for symptom improvement.
Fusion vs. Non-Fusion Spinal Surgery
Non-fusion surgery refers to alternatives to traditional spinal fusion. Fusion alternatives have developed over the years due to the risks and complications associated with conventional fusion procedures.
The Risks of Spinal Fusion
- Extensive recovery period
After spinal fusion, patients generally need to stay in the hospital for a few days. It usually takes 4 to 6 weeks for patients to go back to work, for sedentary professions. However, patients may need 3 months or even longer to return to physical activity.
Patients may not make a full recovery from spinal fusion for 6 months to a year after spinal fusion.
- Loss of mobility in the back
Spinal fusion tends to restrict back mobility. In the area of the back where the fusion was performed, patients often aren’t able to bend, twist, or stretch. Some people require a special tool to pick up items off of the floor after spinal fusion.
- Adjacent segment disease
Adjacent segment disease is a potential complication of spinal fusion. It’s a condition that can develop if the segments around the fused bone undergo more wear and tear to compensate for the fusion. As a result, the affected spinal segments break down more rapidly.
In a study of 237 patients, 6.3% of them developed adjacent segment disease after posterior decompression and instrumented spinal fusion. So, while not all fusion patients will develop this condition, it’s a risk worth noting.
Adjacent segment disease can heighten your risk of developing spondylosis, spondylolisthesis, spinal stenosis, degenerative scoliosis, and herniated disc. It can also cause lower back pain and tingling, weakness, or numbness in the legs or feet.
Non-Fusion Spinal Surgery
Thanks to recently developed medical technology, there are now spinal fusion alternatives available to patients. Non-fusion spinal surgery typically involves spinal decompression, such as decompressive laminectomy, and a spine device to stabilize the spine. With fusion alternatives, you can significantly reduce the length of your spine surgery recovery.
Non-fusion spinal surgery can provide the following advantages over conventional fusion:
- Reduced stay in the hospital (may be an outpatient procedure)
- Shorter, less painful recovery period
- Prevent adjacent segment disease and associated complications
- Preserved spinal range of motion
- Reduced damage to muscle and soft tissue in minimally-invasive non-fusion procedures
Patients with chronic back pain that’s not improved by months of non-invasive treatment should consider talking to their doctors about their options, including fusion and non-fusion procedures.