What is spinal fusion anyway? Why would someone choose neck surgery?

​When patients go in for continual neck and low back pain, they could be found to have chronic pain problems or degenerative disc disease, problems that won’t go away on their own. Instead of leaving them untreated and surely allowing the pain to get worse, spinal fusion surgery is often recommended. This surgery is done by fusing certain segments of the spine together, typically with bone and/or hardware, in order to prevent motion from that particular spinal segment. The idea is that, with little to no motion, further erosion and increased pain cannot occur.

​How well does this surgery work? What is the success rate?

​This answer is a bit more complicated because the research has shown that the success rate for spinal fusion is largely dependent on the reason someone needs surgery in the first place. In the largest published investigation to date, researchers looked at the results of 65 studies and more than 300,000 patients and found that the success rates were variable; there wasn’t, in this study, a definitive answer on the success rate of spinal fusion for surgical patients with low back pain, versus patients with low back pain who opted out of surgery (1). Furthermore, there was no difference in pain levels between those who underwent spinal fusion and those who did not. For patients who had a slipped vertebra (otherwise known as spondylolisthesis), the spinal fusion procedure did have greater success; however, most patients who pursue spinal surgery are not in that category, but instead have chronic neck pain or low back pain. The research shows that, for these patients that make up the majority, the fusion surgery did not make any distinguishable improvements upon their way of life.

​How serious is spinal fusion? Is it a major surgery?

​In a word, yes. Because complications resulting from spinal fusion are common, this procedure is considered major surgery. Research demonstrates that surgeons can underestimate complications (3), and that the serious complication rate of spinal surgery is 10-24%, according to an analysis that reviewed five larger studies on the same subject (4). Even when minimally invasive fusions were used, which are comprised of smaller incisions, the reported complication rate was 19%, with some studies reporting fusion complication rates as high as 31% (10). Side effects from spinal fusion can also include nerve damage and infection, among other problems that can lead to a need for more surgery.

​How will I know if my spinal fusion procedure creates complications? What are the symptoms I should look out for?

​An unfortunate and major complication of spinal fusion surgery is an overall failure of the procedure. Spinal fusion can fail, and there are a few main ways that happens, to include:

➜ Non-union: If the segment being fused with the bone fails to grow together, this is called “non-union.” The rate at which non-union occurs is highly dependent upon the type of spinal fusion surgery performed. If a procedure requires more bone, such as a posterior-lateral fusion, non-union rates can be as high as 26 – 36% (8,9)

➜ Hardware that loosens or breaks, or pain resulting from hardware used: These hardware-centric complications are a common reason that second surgeries need to be performed after the initial fusion. Overall, roughly 13% of patients undergoing fusion because of low-back problems require a second surgery (11).

➜ Adjacent segment disease (ASD): ASD is caused by excessive force on vertebral levels above or below the fusion area, causing them to be worn out because of the immobile fusion (12). It is estimated that as many as 12% of patients will develop ASD within two years of their spinal fusion procedure (16), and 2 – 4% of patients will develop this problem for every year post-fusion, for example, at 5 years from the fusion date, 20% of patients will have developed ASD (17).

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 Life is too short to live in pain. If you’ve been recommended spine surgery, we want to provide you an alternative to spinal fusion that minimizes complications and ensures optimal and lasting results. Take advantage of our innovative treatments that help people just like you avoid joint replacement and other invasive surgeries, allowing them to get back to doing the activities they love, faster and without surgery.

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References

​(1) Yavin D1, Casha S1, Wiebe S, Feasby TE, Clark C, Isaacs A, Holroyd-Leduc J, Hurlbert RJ, Quan H, Nataraj A, Sutherland GR, Jette N. Lumbar Fusion for Degenerative Disease: A Systematic Review and Meta-Analysis. Neurosurgery. 2017 May 1;80(5):701-715. doi: 10.1093/neuros/nyw162.

(2) Wang X, Borgman B, Vertuani S, Nilsson J. A systematic literature review of time to return to work and narcotic use after lumbar spinal fusion using minimal invasive and open surgery techniques. BMC Health Serv Res. 2017;17(1):446. Published 2017 Jun 27. doi: 10.1186/s12913-017-2398-6

​(3) Ratliff JK, Lebude B, Albert T, Anene-Maidoh T, Anderson G, Dagostino P, Maltenfort M, Hilibrand A, Sharan A, Vaccaro AR. Complications in spinal surgery: comparative survey of spine surgeons and patients who underwent spinal surgery. J Neurosurg Spine. 2009 Jun;10(6):578-84. doi: 10.3171/2009.2.SPINE0935.

​(4) Zaina F, Tomkins-Lane C, Carragee E, Negrini S. Surgical versus non-surgical treatment for lumbar spinal stenosis. Cochrane Database Syst Rev. 2016;2016(1):CD010264. Published 2016 Jan 29. doi:10.1002/14651858.CD010264.pub2
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(5) Adogwa O, Parker SL, Bydon A, Cheng J, McGirt MJ. Comparative effectiveness of minimally invasive versus open transforaminal lumbar interbody fusion: 2-year assessment of narcotic use, return to work, disability, and quality of life. J Spinal Disord Tech. 2011;24(8):479–484.  https://www.ncbi.nlm.nih.gov/pubmed/21336176

(6) Parker SL, Adogwa O, Bydon A, Cheng J, McGirt MJ. Cost-effectiveness of minimally invasive versus open transforaminal lumbar interbody fusion for degenerative spondylolisthesis associated low-back and leg pain over two years. World Neurosurg. 2012 Jul;78(1-2):178-84. doi: 10.1016/j.wneu.2011.09.013.

(7) Parker SL, Mendenhall SK, Shau DN, Zuckerman SL, Godil SS, Cheng JS, et al. Minimally invasive versus open Transforaminal lumbar Interbody fusion for degenerative Spondylolisthesis: Comparative effectiveness and cost-utility analysis. World Neurosurg. 2013. https://www.ncbi.nlm.nih.gov/pubmed/23321379

​(8) Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg Am. 1991 Jul; 73(6):802-8. https://www.ncbi.nlm.nih.gov/pubmed/2071615/

(9) Tsutsumimoto T, Shimogata M, Yoshimura Y, Misawa H. Union versus nonunion after posterolateral lumbar fusion: a comparison of long-term surgical outcomes in patients with degenerative lumbar spondylolisthesis. Eur Spine J. 2008;17(8):1107–1112. doi: 10.1007/s00586-008-0695-9

(10) Joseph JR, Smith BW, La Marca F, Park P. Comparison of complication rates of minimally invasive transforaminal lumbar interbody fusion and lateral lumbar interbody fusion: a systematic review of the literature. Neurosurg Focus. 2015 Oct;39(4):E4. doi: 10.3171/2015.7.FOCUS15278.

​(11) Greiner-Perth R, Boehm H, Allam Y, Elsaghir H, Franke J. Reoperation rate after instrumented posterior lumbar interbody fusion: a report on 1680 cases. Spine (Phila Pa 1976). 2004 Nov 15;29(22):2516-20. https://www.ncbi.nlm.nih.gov/pubmed/15543064

(12) Saavedra-Pozo FM, Deusdara RA, Benzel EC. Adjacent segment disease perspective and review of the literature. Ochsner J. 2014;14(1):78–83. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3963057/

(13) MacDowall A, Canto Moreira N, Marques C, Skeppholm M, Lindhagen L, Robinson Y, Löfgren H, Michaëlsson K, Olerud C. Artificial disc replacement versus fusion in patients with cervical degenerative disc disease and radiculopathy: a randomized controlled trial with 5-year outcomes. J Neurosurg Spine. 2019 Jan 11;30(3):323-331. doi: 10.3171/2018.9.SPINE18659.

(14) Yang X, Janssen T, Arts MP, Peul WC, Vleggeert-Lankamp CLA. Radiological follow-up after implanting cervical disc prosthesis in anterior discectomy: a systematic review. Spine J. 2018 Sep;18(9):1678-1693. doi: 10.1016/j.spinee.2018.04.021.

(15) MacDowall A, Skeppholm M, Lindhagen L, Robinson Y, Löfgren H, Michaëlsson K, Olerud C. Artificial disc replacement versus fusion in patients with cervical degenerative disc disease with radiculopathy: 5-year outcomes from the National Swedish Spine Register. J Neurosurg Spine. 2018 Nov 2;30(2):159-167. doi: 10.3171/2018.7.SPINE18657.

(16) Zhong ZM1 Deviren V, Tay B, Burch S, Berven SH. Adjacent segment disease after instrumented fusion for adult lumbar spondylolisthesis: Incidence and risk factors. Clin Neurol Neurosurg. 2017 May;156:29-34. doi: 10.1016/j.clineuro.2017.02.020.

(17) Tobert DG, Antoci V, Patel SP, Saadat E, Bono CM. Adjacent Segment Disease in the Cervical and Lumbar Spine. Clin Spine Surg. 2017 Apr;30(3):94-101. doi: 10.1097/BSD.0000000000000442.

(18) Centeno C, Markle J, Dodson E, et al. The use of lumbar epidural injections for treatment of radicular pain. J Exp Orthop. 2017;4(1):38. Published 2017 Nov 25. doi: 10.1186/s40634-017-0113-5