Patient education: Thoracic or lumbar spinal fusion (The Basics)

What is thoracic or lumbar spinal fusion? — Spinal fusion is surgery to permanently join 2 or more bones together in the spine. Then, there is no movement between those bones anymore. "Thoracic" and "lumbar" mean the middle and lower parts of the spine (figure 1).

The back is made up of (figure 2):

●Vertebrae – These are the bones of the spine. Each has a hole in the center. The vertebrae are stacked to form a hollow tube called the "spinal canal." The spinal cord passes through this tube and is protected by the vertebrae.

●Spinal cord and nerves – The spinal cord is the bundle of nerves that connects the brain to the rest of the body. It runs through the vertebrae. Nerves branch from the spinal cord and pass in between the vertebrae. From there, they connect to the arms, the legs, and the organs.

●Discs – Rubbery discs sit in between each of the vertebrae. These add cushion and allow movement.

●Muscles, tendons, and ligaments – These support the vertebrae. They are used to move the head and neck, stand upright, and bend and flex the body. They are also called the "soft tissues" of the neck and back.

Problems with any of these can impact how the spine is aligned, or cause pain, numbness, or weakness.

Why might I need thoracic or lumbar spinal fusion? — Doctors do spinal fusion surgery for a variety of conditions. Examples of conditions that might be treated with spinal fusion include:

●Spinal stenosis (figure 3) – A condition in which the spinal canal is narrowed. This can squeeze or press on the nerves.

●Spondylolisthesis – A condition where a spinal bone is not in line with the others.

●Kyphosis or scoliosis – A condition in which there are abnormal curves in the spine.

●A spinal injury or broken bone

Spinal fusion can stabilize a weak or unstable spine and might also reduce long-term pain and disability. Sometimes, spinal fusion is done along with other procedures to treat infection or tumors of the spine.

How is spinal fusion done? — Doctors can do spinal fusion on any part of the back or neck. Typically, the doctor uses a "bone graft" to join, or fuse, the bones together. The bone graft might come from the person or from a bone bank. The doctor might also use screws and rods to hold the bones in place. Sometimes, they will also remove bone or tissues that are pressing on the spinal cord or nerves before doing the fusion (figure 4).

Spinal fusion can be done in 2 ways:

●Open surgery – During an open surgery, the doctor makes a cut, or "incision," in the skin. This lets them see directly inside the body when they do the surgery.

●Minimally invasive surgery – "Minimally invasive" surgery lets the doctor make smaller incisions in the skin. The doctor might use imaging tests to help place the screws and rods. (Imaging tests like X-rays and CT scans create pictures of the inside of the body.) The doctor can control the tools used in surgery directly, or with the help of a robot (this is called "robot-assisted" surgery).

The goal of minimally invasive surgery is to help you return to normal activities sooner. However, for both types of surgery, it can take a year or so before you fully return to your normal activities.

The doctor can choose between 3 different approaches:

●"Anterior approach" – The doctor reaches the spine from the front of the body.

●"Posterior approach" – The doctor reaches the spine from the back of the body.

●"Lateral approach" – The doctor reaches the spine from the side of the body.

How do I prepare for thoracic or lumbar spinal fusion? — The doctor or nurse will tell you if you need to do anything special to prepare. Before your procedure, your doctor will do an exam. They might send you to get tests, such as:

●X-rays, CT or MRI scans, or other imaging tests

●Lab tests

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●Eating and drinking before your procedure – In some cases, you might need to "fast" before surgery. This means not eating or drinking anything for a period of time. In other cases, you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure you are having.

●Lowering the risk of infection – In some cases, you might need to wash the area with a special soap.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during thoracic or lumbar spinal fusion? — When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get general anesthesia. This makes you unconscious so you can't feel, see, or hear anything during the procedure. You might also get a breathing tube to help you breathe.

●You might get medicines to help control pain after the procedure.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●The doctor will make an incision in your skin. They will gently move the muscles and tissues, so they can see your spine.

●Sometimes, they might remove bone or tissue that is pressing on your nerves.

●They will use a bone graft to join the bones together. This is bone that comes from somewhere else. In most cases, it is taken from bone that is removed during the procedure. In some cases, the bone comes from another part of your body, like your hip. In other cases, specially prepared bone from a donor is used. The bone graft helps with bone healing.

●After the bone graft is in place, the doctor might use screws and rods to hold the bones in place.

●They might place a drain tube in your back close to the incision. This will get rid of any extra fluid or blood from around the incision. The drain tube is hooked to a collection bulb. The fluid is emptied from the bulb each day until the drain is removed.

●The doctor will close your incisions and cover them with clean bandages.

●The procedure usually takes 4 to 8 hours.

What happens after thoracic or lumbar spinal fusion? — After your procedure, you will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. Most people stay in the hospital for about 3 to 4 days after surgery.

As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●If you had a breathing tube, you might have a sore throat. This usually gets better quickly.

●The staff will help you get out of bed and start moving around when you are ready.

●You will get medicine if needed to help with pain. You might need other medicines, too.

●You can start eating as you are able. You might feel better if you start with bland foods.

What are the risks of thoracic or lumbar spinal fusion? — Your doctor will talk to you about all of the possible risks, and answer your questions. Possible risks include:

●Infection

●Bleeding

●Leaks of a fluid called "cerebrospinal fluid"

●Blood clots

●The bones not fusing correctly

●Symptoms not going away

●The hardware used in surgery moving out of place

●Spinal cord or nerve damage

●Stiffness and/or pain

●Problems with bowel or bladder function

●Needing more surgery in the future

What else should I know? — Before you go home from the hospital, make sure that you know what problems to look out for and when you should call the doctor. Make sure that you understand your doctor's or nurse's instructions. Ask questions about anything you do not understand.

More on this topic

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Patient education: Lumbar spinal stenosis (The Basics)
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Patient education: Vertebral compression fracture (The Basics)
Patient education: Herniated disc (The Basics)
Patient education: Scoliosis (The Basics)
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