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Spinal Fusion: Understanding Indications, Benefits & Procedure

Spinal fusion (arthrodesis) permanently joins two or more vertebrae, eliminating motion at that segment to relieve pain from instability or deformity.

Common Indications

  • Degenerative disc disease with instability (dynamic X-ray: >3mm translation, >10° angular motion).
  • Spondylolisthesis (grade ≥2 or symptomatic grade 1): forward slip of vertebra.
  • Spinal stenosis with instability or deformity requiring decompression + fusion.
  • Deformity: Scoliosis (adolescent/adult), kyphosis (Scheuermann's, post-traumatic).
  • Trauma: Unstable fractures (burst, fracture-dislocation).
  • Tumor/infection: Reconstruction after resection/debridement.
  • Pseudoarthrosis: Failed prior fusion.
  • Adjacent segment disease: Symptomatic degeneration above/below prior fusion.

Surgical Techniques

  • Approach: Anterior (ALIF, LLIF/XLIF, OLIF), Posterior (PLF, PLIF, TLIF), Lateral, Combined (360°).
  • Instrumentation: Pedicle screws + rods (posterior), interbody cages (PEEK, titanium) + bone graft.
  • Bone graft: Autograft (iliac crest – gold standard), allograft, BMP-2, synthetic (ceramic, DBM).

Outcomes & Risks

BenefitsRisks/Complications
Pain relief (70-90% for appropriate indications)Pseudoarthrosis (non-union): 5-15% (↑ smoking, diabetes, NSAIDs, osteoporosis)
Stability, deformity correctionAdjacent segment disease (ASD): 2-4%/yr
Neurologic decompressionInfection (1-4%), hardware failure, nerve injury, DVT/PE
Improved function/quality of lifeChronic pain, donor site morbidity (autograft)

Recovery

  • Hospital: 1-3 days (minimally invasive); 3-5 days (open).
  • Brace: 6-12 weeks (surgeon-dependent).
  • PT: start 4-6 wks; core strengthening, gait training.
  • Fusion consolidation: 6-12 months (CT confirms).
  • Return to work: 6-12 wks (sedentary); 3-6 mos (heavy labor).

Decision-Making

Fusion is irreversible. Exhaust non-operative care (PT, injections, medications) unless instability, deformity, or neurologic deficit mandate surgery. Shared decision-making with spine surgeon.

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