Back pain is a constant topic in American life. Eighty percent of us experience it at one time or another and it is the second most common reason for doctor visits in the United States. There are a number of non-surgical treatments for back pain, and 90% of patients who receive treatment at the New England Baptist Hospital Spine Center do not need surgery. However, when non-operative treatments fail, surgery may be the best option for relieving your pain and/or restoring function. Dr. Raymond Hwang, an orthopedic surgeon specializing in the back, neck and spine at NEBH, explains one type of surgery, spinal fusion, what you should ask your surgeon, and what you can expect after surgery.
A spinal fusion is one type of procedure that can be used to treat back pain. It is performed to stabilize unstable vertebra, or to correct an abnormal spinal curvature. The fusion is achieved by connecting two or more spinal bones (vertebra) together. Using spinal implants (e.g. rods and screws) helps hold the vertebra in place while the bone grows, increasing the chance of successful fusion of the bone. There are many different ways to perform a fusion depending on the particular problem. Your surgeon can discuss which ones may be best for you.
When discussing spine surgery with your physician, it is important to understand how your MRI or CAT scan findings relate to your symptoms, what the proposed surgery will do with regard to those findings, and how the surgery is expected to improve your symptoms and quality of life. Often there is more than one surgical option, so it is important to understand the pros and cons of each option so you can choose the surgery that is best for you. It is also important to understand what to do before and after surgery to ensure the best possible outcome. This includes any post-operative activity restrictions, wound care and exercises.
After a successful fusion, most patients can return to their normal activities and lifestyle. A fusion does remove the normal motion that exists between the vertebra, so a feeling of mild stiffness can occur. Although many patients are concerned about their forward bending ability after surgery, this is not usually significantly impacted in a lumbar fusion because most forward bending occurs at the hips.
Recovery after a spinal fusion varies based on a number of factors, including how many bones are fused, the location of the fusion, and how the fusion is performed. A typical neck fusion may involve an overnight stay in the hospital, while a low back fusion can involve spending 3 days in the hospital. It is important to keep in mind that while many patients experience improvement of their symptoms early in the post-operative period, bone healing (fusion) can take months, sometimes even a year or more.
Patients with very physical jobs may require 2-3 months off of work to prevent interference with bone healing, but those with more sedentary jobs can often return to work much sooner. More vigorous activities are typically avoided for the first 8 weeks to give the bones the best chance of healing.