Dr. Zarina Ali
Got back pain? You're not alone. It's a common problem—about 80% of US adults have had back pain at some point in their lives.
Your treatment will depend on the cause of your pain. If it's due to excessive movement of vertebrae—the bones that make up the spine—one treatment option is spinal fusion surgery.
If it sounds scary, keep this in mind: It can have amazing results. "For the right patient, it can be a gratifying operation to treat back pain," says Zarina Ali, MD, physician and neurosurgeon at Penn. "And it's routinely performed at Penn."
The 5 "W's" of spinal fusion surgery
Considering spinal fusion surgery? Here are 5 "W's" to know about—the who, what, where, when, and why.
Who
While it's a common surgery, spinal fusion is appropriate only for a certain subset of patients. "A lot of people come in with back or neck pain, but not many actually need the fusion operation," Dr. Ali explains.
"One of the main reasons I perform spinal fusion surgery is axial pain," says Dr. Ali. "But I may also perform surgery due to a number of other circumstances. For example, a patient may need surgery if he or she has suffered from a trauma that has led to spinal instability."
Spinal fusion surgery may also be performed for a variety of medical conditions or back deformities. Dr. Ali sometimes sees spondylolisthesis—a problem in which one vertebra (bone) slips onto another, causing pain.
Spinal fusion surgery might also be performed when a patient has:
- Fractured (broken) bones from a traumatic injury
- Abnormal curvatures of the spine from conditions like scoliosis
- An unstable or weak spine due to tumors or infections
- Degenerative disc disease resulting in mechanical back pain
- Select instances of chronic (long-lasting) lower back pain
What
During the procedure, the surgeon connects two or more vertebrae. This prevents motion in that area and can reduce pain from conditions like arthritis. The goal is to fuse the vertebrae together to prevent abnormal motion of the spine.
With any spinal fusion surgery, the goal of surgery is to create bone across two segments of vertebrae. Small pieces of bone are usually placed in the space between the vertebrae that are going to be fused. This allows for bone production so the vertebrae can heal and become a single solid segment of bone.
But the process doesn't end there. The vertebrae need to be held together, usually using plates, screws and rods to keep that segment of the spine immobile.
Where
Spinal fusion surgery can be performed on any segment of the spine, including cervical, thoracic, lumbar, and/or sacral regions.
—Zarina Ali, MD, Neurosurgeon, Penn Medicine
When
The decision to perform spinal fusion surgery isn't a simple one. "We can only decide to do spinal fusion surgery after we've taken several steps," says Dr. Ali.
That includes:
- Performing imaging tests and clinical exams
- Making a specific diagnosis
- Making a judgment as to if, and how much, symptoms can be relieved through surgery.
Often times, spinal fusion surgery is performed following other spinal surgeries that address different spinal problems:
Discectomy
This procedure is performed when someone has a herniated disc—meaning all or part of the jelly-like material between the vertebrae has been forced through a weak part of the spine. It's typically an outpatient procedure, allowing a patient to go home the same day following surgery.
Laminectomy
In this procedure, surgeons create more space for the nerves inside the spinal canal. They do this by removing the bone covering the spinal column as well as overgrown ligaments that are pushing on spinal nerves.
They also might remove bone spurs, disc fragments, or other arthritic tissue. The goal is to take pressure off of the nerves and relieve pain. At Penn Medicine, a laminectomy may be performed at the same time as spinal fusion, as determined by the surgeon.
Why
The goal of spinal fusion surgery is to stabilize parts of the spine. This treatment can lead to a better quality of life for certain patients who experience chronic back pain.
It might take several months before your bones fully fuse. A rehabilitation specialist or another medical professional will teach you correct ways to move, walk, sit, and stand, so that the bone remains aligned correctly.
Over time, you should notice reduced pain in your back. You can increase your odds of avoiding pain by maintaining a healthy weight and lifestyle. Talk to your surgeon about how you can protect your back in the future.