Performed by – Sri Chatakondu, Sarmad Kazzaz, Mark Thomas, Adam Way

Reasons for fusion surgery
This is a procedure that aims to join two or more vertebrae together. It is generally considered due to unstable or degenerate discs that stop functioning lead to pain. If all other avenues of treatment have been tried or considered, then your surgeon may discuss fusion surgery to improve back and leg symptoms.

Main types of fusion
Anterior lumbar fusion (ALIF) – Performed through an incision at the base of your abdomen Lateral lumbar fusion (XLIF or DLIF) – Performed through an incision through the side/flank of your abdomen Posterior lumbar fusion (PLIF, TLIF, MIDLIF) – Performed through an incision through your back.

Different conditions lend themselves to different types of fusion surgery and this will be discussed with your surgeon. Fusing 1 or 2 levels of the spine does not dramatically impact on patient’s movements or abilities with daily tasks and can lead to a big improvement of symptoms. The aim of surgery is to improve your level of pain, allowing for a more comfortable life.

Procedure
The surgeon and anaesthetist will discuss the procedure at length with you. It will take a few hours in theatre, where you will be carefully monitored and x-rays will be taken during the procedure to assist the surgeon. Afterwards you will start the recovery and rehabilitation phase with the nurses and physiotherapists on the ward. You should generally expect to leave hospital 2-5 days after the surgery.

Risks of fusion surgery
The benefit of relieving pressure on the nerves can be immediate but sometimes takes months to recover. The bones will usually take 6-9 months to solidly fuse and thus back pain symptoms rarely improve in the early weeks/months. Although it is often successful surgery in improving symptoms, there are risks with the surgery.

Infection – Antibiotics are given in theatre and afterwards to reduce the chance of infection but it is still about 1%. This can usually be treated with a course of antibiotics but may require a further surgical procedure.

Bleeding – There is always a small amount of blood lost during any surgery but the risk of requiring a blood transfusion is very small. At times we can collect your own blood and then give it back to you in theatre.

Non union – We aim to join 2 bones together but there is a risk that the bones may not join up properly, called non union. If this occurs this can lead to ongoing pain and further repeat fusion surgery can be considered but carries higher risks. It is vital that you consider stopping smoking pre fusion surgery as this cuts down successful fusion rates by around 50%.

Dural Tear – The brain, spinal cord and nerves are bathed in cerebrospinal fluid (CSF), which is housed in a sheath called the dura, which is as thin as tissue paper. There is a risk of puncturing this membrane which can lead to headache symptoms. These symptoms last for a few days and then settle, but very rarely further surgery to close the leak may be discussed.

Nerve Injury – During surgery the nerves are decompressed and manipulated and the implants are inserted very close to the nerves. This can result in damage, which is often temporary but can be permanent. This can lead to symptoms of ongoing pain, numbness or weakness in the leg. The chance of paralysis is possible but very rare with fusion surgery.

Cauda Equina syndrome – Both during and after surgery, a blood clot can put pressure on the nerves passing the operation area. These nerves pass the area to supply the bladder, bowel and sexual function nerves. If pressure is significant, this can lead to a loss of bladder/bowel and sexual function permanently but the risk of this approximately 1 in 5000.

Review / Follow-up from fusion surgery
It is important patients follow the guidance of their surgeon and physiotherapist for the best rehabilitation following fusion surgery. It is vital patients perform regular exercises to prevent the back going into spasm. Patients will generally be discharged a few days after surgery and then see their GP or GP Practice nurse at 2 weeks for a review of the wound. They will then be followed up by their surgeon at 6-8 weeks post operatively.