What is fusion? How is spinal fusion achieved?
Fusion is the procedure of stabilizing two or more vertebra together and uniting them. Instrumentation with implants such as screws, rods, and cages may or may not be used to achieve bony fusion. Such instruments may be used both for deformity correction and providing internal support for the bones until fusion is achieved.
Using bone or bone-like materials increases the chances of fusion in both instrumented and non-instrumented procedures. The most frequently used graft materials are:
- Autogrefts: Harvested from the patient, autografts are the gold standard for achieving a fusion. It can be harvested from the surgical fields or from some other reserve bones of the body.
- Allogreft: Prepared industrially from cadaver bones. Fusion rates are lower and the healing period is longer when compared to autografts. Its advantage is that it is readily available and harvesting is not required—eliminating possible complications related to the harvesting procedure, such as pain.
- Synthetic grefts: Mostly calcium-based materials. Fusion rates are comparable to auto and allografts, especially in childhood and adolescence due to increased healing potential at these ages.
When is spinal fusion required?
Fusion can be performed for deformities such as scoliosis, kyphosis, and spondylolisthesis or for traumas.
The process of deciding whether to choose fusion and surgery, and select among fusion levels, is very complicated. The decision is based on a patient’s age, activity level, diagnosis, and many other factors. Therefore, it is important to discuss all aspects of fusion surgery with your surgeon and be involved in the surgical decision.
How is the recovery period after spinal fusion surgery?
After discharge, one week of rest is recommended, which is not a continuous bed rest. The frequency and duration of mobilization should be increased each day. Any limitation in walking distance and duration is not advised as long as the pain can be tolerated. Yet, sitting duration should be increased in increments. Prescription pain medication is advised for the first week, and may gradually decrease and stop within two to three weeks.
What movements should be restricted during the recovery period of a spinal fusion surgery?
The patient can lie on the back, on the side, or facedown. Limited forward and side bending as well as rotational movements are permitted, but not the full range of motion. For example, you may bend to wash your face, but not to tie your shoes.
When can one return to school after fusion surgery?
Most patients can return to schools three weeks after the operation. If you can sit and walk three to four hours throughout a day, it is probably time to return to school. It is generally recommended not to attend the physical education classes for one year.
Which sports are allowed after scoliosis surgery?
Types of sport activities and the time required to return to these activities vary by fusion levels. Therefore, you should discuss it with your surgeon.
Generally, it is not recommended to do any sport in first three months. One can return to swimming and jogging generally at the third month. Contact sports such as as basketball, football, martial arts, and sports that have an increased risk of falling, such as horse riding, can be returned one year post operation.
What should I expect from the fusion surgery?
The major aim of the scoliosis surgery is to halt the progression of the curve in order to prevent possible pain problems as well as heart and lung dysfunctions. This should be achieved by getting the most correction with fusing as few segments as possible to preserve spinal mobility.
Preserving the spinal mobility is much more important than achieving cosmetic improvement. Spinal mobility is an inevitable element for quality of life. Cosmetic improvement is also important; however, it is a secondary aim. Patient safety and spinal mobility cannot be ignored while trying to achieve perfect cosmetic improvement. Spinal mobility is very important for the quality of your future life. It is important to have a balanced spine post-operation.
The cosmetic problems of scoliosis are hump appearance in the back, trunk shift, and shoulder height difference, and among them, the hump appearance is surgically the most difficult one to correct. A substantial improvement may be achieved, however, some asymmetry can still be observed in forward bending after surgery. This residual asymmetry can be eliminated with thoracoplasty procedure, which has its inherent possible complications. Discuss advantages and disadvantages of this technique with your doctor.
The gold standard treatment of scoliosis is posterior spinal fusion, as the fusion of the lumbar spine can result in limited movements. Limitations in forward and side bending are more prominent in the early post-operative period, after which adaptations occur. Many patients get used to this “new situation” of their spine in a few months and feel no limitations in the activities of daily life. Yet, it is better to save as many lumbar levels as possible.