Simply put, a spine fusion is where the body attempts to grow new bone in an area that had no prior bone. Surgeons typically perform fusion surgery for instability of the spine, fractures, tumors, infections, painful discs. Cages (spacers), screws, plates and bone-like material help the body create/ grow new bone. Instrumentation is used to stabilize the spine so the fusion process can occur…similar to a cast for a broken ankle. The steps required to grow new bone can sometimes take 5-6 months or longer.
So then, why is fusion bad? Prior to the technology explosion in Spine (mid to late 90’s) and the use of MRI, identifying where pain was coming from was elusive. Even today, surgeons encounter difficulty in trying to figure out exactly what hurts. Certain body parts such as discs (shock absorbers in between the spine bones) can cause leg, butt or back pain. We often encounter people who have had spine surgery and experienced bad results. Unfortunately, we hear about bad results more than we hear about good results. Fusion surgery is not for everyone. In cases where you are unsure of where the majority of the pain is coming from…fusion is a poor option. However, in selected cases, fusion can improve activity levels and decrease pain.
One thing fusion is not, is a cure. As surgeons we are immobilizing a segment of the spine that was intended to be a moving part. The price of a fusion is that the other moving parts of the spine compensate and now work harder. This additional work means that there is an increased risk of other levels wearing out sooner. Think of your car, if you remove 1 shock absorber and are left with 3…how long will they last? Fusion is an attempt to improve quality of life. The surgery cannot make a patient pain free and feeling as if they never had any spine problems. Outside of fractures, tumors or infections….most spine surgery is a “last option” after having tried non surgical treatments.
Paul Saiz, MD