To Fuse or Not To Fuse

The decision to fuse a spinal segment, let alone numerous segments, should never be taken lightly. Loss of motion from spinal fusion has a tremendous potential impact to a patient.

How will a spinal fusion affect a tall spine? There are a couple of obvious possibilities. In the best scenario, stopping painful movement of spinal segment lets the patient go on to have a much better quality of life with less pain. In this near perfect scenario, the spinal segments adjacent to the fusion quietly pitch in and help to take over the normal spinal motion, and the patient doesn’t really notice any substantial difference in motion after they heal. The patient goes on to live an awesome life. Think Tiger Woods winning the Masters Golf Championship after a lumbar fusion, or Peyton Manning winning the Super Bowl after a cervical fusion.

On the contrary, a worst-case scenario is that eliminating motion of a moving spinal segment could put unwanted stress on adjacent segments, leading to their demise and need for further surgery. You and your surgeon want to avoid this scenario at all costs. So how do you achieve the former and not the latter? There are many considerations, some in your surgeon’s control, and some in your control.

Your surgeon has a leading role in this success model. When a surgeon performs a spinal fusion, it is important that they minimize, or eliminate completely, any disruption of supporting tissues adjacent to the fused segment. See more about minimally invasive spinal fusion.

The surgeon must also skillfully create appropriate spinal alignment when fusing a segment. Fusing the spine in the same miserable position that gave you pain does you no service, The surgeon must execute proper decompression of the affected nerves, proper preparation of the fusion site and delivery of the biologic fusion material, and place the stabilizing instrumentation accurately.

You too have a pivotal role in this success model with some key responsibilities. Obviously you need to show up as healthy as possible. Optimize any comorbidities like obesity, diabetes, and heart disease. Eliminate or greatly reduce any environmental factors like smoking and pain medication usage. Come to the surgery with total confidence in your surgeon. This means show up with no doubt you chose the right surgeon. Make sure you acted as CEO of your health care and made your surgeon decision based on real data, not just the advice of your doctor or health care system. Finally, post-operatively follow the plan that you and your surgeon constructed.

Here are some other very general considerations to help you decide about spinal fusion. Before you read these, I urge you to consider my very strong opinion that, given a choice between spinal fusion or a motion sparing surgery, CHOOSE THE MOTION SPARING SURGERY!

When to Consider Spinal Fusion:

Conditions Treated:
• Severe scoliosis or spinal deformities.
• Degenerative disc disease or spinal instability.
• Spondylolisthesis (slipping vertebra).
• Spinal fractures.
• Chronic, debilitating pain unresponsive to other treatments.
• Failed Conservative Treatments:
• Physical therapy, medications, injections (including regenerative injections!), or lifestyle modifications haven’t worked.

Pros of Spinal Fusion:

Pain Relief: Reduces movement at painful joints.
Improved Stability: Helps in cases of instability or deformity.
Potential for Better Quality of Life: If successful, it can enable resuming activities.
Cons of Spinal Fusion:
Irreversible: The fused area loses flexibility permanently.
Adjacent Segment Disease: Increased stress on nearby vertebrae can cause
degeneration over time.
Variable Success Rates: Not all patients experience relief.
Recovery Time: Healing can take months, with potential complications like infection
or nerve damage.

Alternative to Explore:

Non-surgical options: targeted exercises, spinal injections including regenerative injections like PRP or stem cells, or pain management techniques.

Minimally Invasive procedures: like artificial disc replacement, selective laminectomy or discectomy or nerve ablations, depending on your condition.

Key Step:

Consult with a very competent spine specialist. Ask about imaging tests (e.g., X-rays, MRIs) to confirm the need for fusion and whether alternative treatments could work for your specific condition. Look for more to come about fusion techniques in another episode.

Until next time,

Neurosurgeon
aka – The Tall Spine