Spinal Fusion Surgery - Pictures, Procedure, Risks & Recovery

Spinal fusion surgery prevents motion between the operated fused vertebrae. It can be performed at any level of the thoracic, cervical, or lumbar spine. The spinal fusion surgery straightens the curved spine and prevents it from worsening over time. Spinal fusion surgery fills the space between the two vertebrae with a bone or bone-like material. The metal plants, rods, and screws are used to hold together the vertebrae so they can heal into one solid bone. 

Anatomy and Physiology of the Spine

The spine is the body’s central support structure and has three natural curves, which make an S-shape. It controls the movements in our body and helps us to stand, sit, walk, bend and twist. The spine in the human body is made up of different parts:

1. Vertebrae: The spine is made of 33 small bones stacked together, called vertebrae. It forms the spinal canal, a tunnel containing the spinal cord and spinal nerves. It helps in protecting the spine from injury. Most of the vertebrae allow the range of movement. However, the lower vertebrae (coccyx and sacrum) do not move and are fused. 
2. Intervertebral disc: The flat and round cushion-like structure between the two vertebrae is called the intervertebral disc. Each intervertebral disc has a gel-like pulpous centre surrounded by a flexible outer ring called the annulus. 
3. Facet joints: Facet joints provide stability and flexibility in the spine and help us to twist and turn 
4. Spinal cord and nerves: A column of the spinal nerves which travels through the spinal canal is called the spinal cord. The spinal cord starts from the lower of the skull and extends up to the lower back. Almost 31 pairs of nerves come out through vertebral openings, which carry messages from the brain and muscles.
5. Soft tissues: The spine is supported by ligaments, tendons, and muscles. The ligaments connect the vertebrae and help hold the spine in the position. A tendon connects the muscles to the bones and helps in the movement. The muscles of the spine support the back and help in the movement.

The surgeon performs spinal fusion surgery to treat and provide relief from spinal problems. It assists in correcting the deformity, improves stability and reduces pain. The surgery is required in patients suffering from:

1. Injury or fracture caused by accident to the bones of the spine
2. Spondylolisthesis, in which one vertebrae slips forwards on top of the other spine
3. Abnormal curvatures in the spine, such as in case of scoliosis and kyphosis
4. Herniated disc or degenerative disc
5. Spine weakness caused due to tumour
6. Spinal stenosis (arthritis in the spine)
7. Spinal infection caused due to bacteria
8. A genetic disorder in the spine, such as spinal muscle atrophy that may lead to scoliosis

 The Spinal Fusion Surgery is performed in the following steps:

1.  Firstly, the doctor will give anaesthesia, making the patient calm down and sleep during the surgery.
2. The vital signs are carefully monitored during the surgery, and the patient may have a breathing tube inserted into the mouth, allowing them to breathe.
3. The doctor will then clean the operated area and make a small incision on the back or the side.
4. Muscles and tissues will be separated to expose the spine using special tools.
5. Once done, the surgeon will remove the intervertebral disc between the affected vertebrae.
6. The surgeon will use the graft to hold the bones together permanently. The different ways used by the surgeon to fuse the vertebrae are:
   1. By placing the bone graft material between the vertebrae.
   2. By placing the strips of bone graft material over the back of the spine.
   3. By placing the special cages between the vertebrae, which may be packed with graft material.
7. An artificial bone graft substitute can be used.
8. The surgeon may get the bone graft from another part of the body, usually from the pelvic bone, called an autograft, or can get the one from the bone bank, called an allograft. 
9. Finally, the surgeon uses the metal plates, rods, or screws to hold the bones in place until they fully heal.
10.  The surgeon will then place the muscles and tissues back in the original position.
11. In the end, the layers of the skin around the incision made are closed with the help of the stitches and the sutures.

Before the Spinal Fusion Surgery

1. The doctor will provide detailed information about how to prepare for the surgery. 
2. The patients may undergo imagining tests and blood tests a few days before the surgery. 
3. The patients should inform the doctor about their medicines, herbs, vitamins, or supplements. 
4. If the patient is a smoker, kindly stop smoking a week before the surgery. The patients should also avoid drinking alcohol before the surgery. 
5. The doctor may ask the patient to stop taking some medicines like blood thinners or immunosuppressants almost two weeks before the surgery. 
6. The patient should also not eat anything or drink anything after midnight a day before the surgery. 

On the day of the Surgery

1. The patient should follow the instructions given by the doctor about not eating or drinking before the surgery. 
2. Take medicine prescribed by the doctor with a small sip of water. Kindly reach the hospital on time.
3. Once the patient reaches the hospital, the staff may perform some imagining tests and blood tests before the surgery.
4. The patient will be asked to sign the consent form to allow the doctor to perform the surgery. The nurse will ask to change to the hospital gown. 
5. The patient may also be asked to remove the jewellery if any.
6.  The staff will take the patient inside the operation theatre, where the doctor will perform the surgery.

Spinal fusion surgery is a safe and effective procedure. However, there are some the risks or complications associated with the surgery, such as:

1. Infection at the site of the operation
2. Leakage from the incision
3. Blood clots
4. Damage to the nearby tissue 
5. Increasing uncontrolled pain
6. Risks from the anaesthesia
7. Bleeding
8. Shaking chills
9. Swelling or redness
10. High fever
11. Nerve injury leading to numbness and tingling

Spinal fusion surgery is done when other physical methods and medicines fail to relieve and treat the symptoms. 

1. It is essential to perform spinal fusion surgery as soon as possible. If the surgery is delayed, it will start affecting nearby blood vessels, spinal nerves, meninges, and spinal cord cells. 
2. With time, it will lead to permanent damage to the spine. It wills leads to increased pain and will start affecting regular moments in the body.
3. In the case of the tumour, if the surgery is delayed, cancer will grow in size and start spreading to other parts of the body. Once the cancer is spread, it will become difficult to control it which can eventually lead to death. 

The cost of Spinal Fusion Surgery ranges from ₹80,000 to ₹2,00,000. The cost varies based on the following factors:

1. Type of Spinal Fusion Surgery
2. Age of the patient
3. The medical condition of the patient
4. The type of hospital facility availed - individual room or shared.