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The Ultimate Guide to Spinal Fusion Surgery

July 2, 2018 5 min read
Man throwing son in air after spinal fusion surgery

What is Spinal Fusion Surgery?

As the name suggests, spinal fusion surgery involves the fusion of two or more vertebrae.

We often think of our spine as operating as a collective unit. But, your backbone actually consists of 24 moveable joints. These joints are formed by the meeting (or articulation) of two vertebrae. Under normal circumstances, we don’t notice the parts that make up the whole. That is, we don’t notice the individual vertebrae that make up our spine. But, when we’re in pain? We tend to feel everything.

Spinal fusion surgery addresses this issue by removing one of those 24 joints. Instead of removing a vertebra, spinal fusion involves removing an intervertebral disc and filling that vacant space with bone graft material. As the bone graft matures, the two vertebrae will fuse together. This “welding” together of parts prevents painful movement at the joint level. And, it can help in adding stability back to the spine.

Who Needs Spinal Fusion Surgery?

Spinal fusion surgery can be used to reverse severe cases of the following disorders:

  • Degenerative Disc Disease (DDD): This condition occurs when the discs that protect your spine from everyday forces suffer from wear and tear. If a disc becomes badly damaged enough, then you may need a spinal fusion to give structural support back to the spine.
  • Spinal Stenosis: This disorder involves a narrowing of the spinal canal that houses your spinal cord. If this condition leads to compression of the spinal cord, then you may need a spinal fusion to reverse symptoms. If you have a healthy spine, your doctor may be able to perform a less intense procedure (like a laminectomy). However, if you have osteoporosis or severe compression of the spinal cord, then your condition may require fusion.
  • Spondylolisthesis: This condition occurs when a vertebra slips out of alignment with the rest of the spinal column. This can occur for a number of reasons, but typically a defect in the bone and/or trauma to the back side of the spine is present. When surgery is indicated for this condition, a spinal fusion is often the preferred method. That’s because less invasive procedures also tend to be less successful at holding the slipped vertebra back into place.
  • Scoliosis or Spinal Deformity: A skilled surgeon can use spinal fusion to correct spinal deformities, like scoliosis. Using mechanical hardware and fusion, your surgeon can realign the curvature of the spine to relieve your pain.

Other conditions that may require spinal fusion include:

What are the Types of Spinal Fusion?

It may seem obvious… but, the first step in any fusion process involves choosing a route of entry to access the spine. This crucial step also determines what we will subsequently call the procedure.

For example, the basic types of spinal fusion include:

  • ALIF: During an ALIF, your surgeon accesses the spine from the front (or anterior side). (Hence the “A” in ALIF.) Your surgeon will achieve this frontal approach by entering the body through the belly.
  • XLIF: During an XLIF, your surgeon accesses the spine through the psoas muscle. Like the ALIF, the XLIF is performed from the front. However, unlike the ALIF, the XLIF is less risky. (Like me, you may be thinking… so, then why not use the XLIF all the time? But, unfortunately, your doctor can only use the XLIF to repair problems with the lumbar spine. If your spinal issue is thoracic or cervical, then your surgeon must choose another approach.)
  • PLIF: During a PLIF, your surgeon enters your spine from the back (or posterior side). (Hence the “P” in PLIF.)
  • 360 Fusion: This procedure involves fusing the spine from the anterior and posterior sides. A 360 Fusion gives maximum stability to the spine. It is preferred in situations like spinal deformities that require that extra bit of reinforcement to hold the spine in place.
  • TLIF: A TLIF is very similar to a PLIF or 360 Fusion, but your doctor will access from the back side and remove a single facet. From this position, your doctor can perform an anterior or posterior fusion (without the need for multiple incision sites).

How Does the Fusion Process Work?

After your doctor selects a route of entry, he or she will begin the fusion process. If you need to have any damaged discs or bone spurs removed, your doctor will extract these now. In addition, your doctor may install hardware to reinforce or restructure adjacent segments of the spine. (You may need restructuring, for example, if you have a spinal deformity like scoliosis.)

After removing any discs, your doctor will insert a bone graft into the interbody space. (In fact, the “I” in ALIF, PLIF, XLIF, and TLIF stands for “interbody.”)

This bone graft can be sourced from your own hip, a bone bank, or synthetic bone. It can be delivered directly into the interbody space… or your surgeon may choose to use a cage as the delivery method.

A cage is a delivery system with slatted bars. Your doctor inserts bone graft material into the cage; and, as the bone graft matures, it pushes through the bars of the cage to fuse with the spine. Cages are becoming somewhat of the norm when it comes to spine fusion. Evidence suggests that using a cage promotes successful fusion of the vertebrae and accelerates the healing process.

However, regardless of the delivery method that your doctor selects, the end result should be the same. As the bone graft matures, two adjacent vertebrae will fuse into one continuous strip of bone. This provides a permanent solution to many forms of back pain by eliminating painful movement at the joint (or vertebral) level.

What are the Advantages of Minimally Invasive Spinal Fusion?

Not all that long ago, spinal fusion had somewhat of a bad rap in the spine surgery community. That’s because spinal fusion once required both lengthy operative and recovery times for doctors and patients alike. But, what once took 8 hours of surgical time can now be accomplished in 2-3. What changed? The advent of minimally invasive spine surgery.

Now, your surgeon can use tiny instruments and 3D technology to achieve the following:

  • Smaller incisions
  • Less bleeding, scarring, and muscle destruction
  • Real-time visualization of spine tissues
  • Smaller surgical instruments
  • The use of retractors (or guiding tools) to eliminate surgeon error
  • Shorter hospital stays
  • Faster recovery times
  • Less complications or need for revision

Interested in an ALIF, PLIF, TLIF, or XLIF to halt neck or back pain? You too can enjoy the benefits of minimally invasive spine surgery. To explore your options for back pain relief, contact our spine experts at New York City Spine. Dr. Daveed Frazier, board-certified spine surgeon, has over 20 years of experience in performing spinal fusion. For neck and back pain relief that you can count on, contact our team at New York City Spine!