Spinal Cord Injury Surgery

What is Spinal Fusion Surgery?

Spinal fusion is one of the most common surgeries performed in the cervical spine (the neck) and the lumbar spine (the low back). The majority of spinal fusions are performed to treat a pinched nerve in the neck that causes nerve pain in the shoulder and down the arm (often times know as cervical radiculopathy), or it may be performed in the low back when there is a pinched nerve in the lumbar spine leading to nerve pain in the buttock and leg (often times called sciatica or lumbar radiculopathy). While spinal fusions are most commonly performed in the neck and the low back, one of the major misconceptions about this procedure is the purpose of the surgery.

Why might someone get Spinal Fusion Surgery?

The purpose of the surgery is most commonly to treat nerve pain in the arms or legs, and the likelihood of dramatically improving nerve symptoms is extremely high; however, the results of a spinal fusion for neck or back pain are often unreliable. Spinal fusions can be performed for neck and back pain, but this is much less common. A fusion for back pain is usually done if the patient has a stress fracture in their back, or if the patient has significant malalignment in their spine. Back pain from arthritis is not commonly a surgical problem.

Risks associated with Spinal Fusion Surgery

While spinal fusions are extremely reliable and safe procedures, all surgical procedures inherently come with risks. Because there are so many different ways to perform a cervical or a lumbar fusion, it is important to talk with your surgeon about the location and technique specific risk factors. However, in general the biggest risks that most patients are concerned about is an injury to the nerves and the spinal cord. The risk of damaging the spinal cord is extremely low, and there is even a special type of spinal cord monitoring that is performed during the case ensuring that there is no injury to the spinal cord. Risks to the nerve roots are still rare, but slightly more common. These injuries may cause weakness in a select group of muscles after surgery. Additionally numbness after surgery is actually quite common. This is something that often happens as the nerves are trying to heal, but in many patients it completely resolves over time.

Does Bone Grafting Cause Pain in Spinal Fusion Surgery? 

Often times patients are concerned about pain after surgery and pain from bone grafting with surgery; however it is important to remember that spine surgery has advanced dramatically over the last 50 years ago. A combination of changes in surgical techniques as well as improvement in biological grafting options have almost completely eliminated the need for collecting bone graft from a separate location. In the cervical spine, the majority of fusions can be done in a minimally invasive manor, with an incision only about 1- 2 inches in length.  Because of this, postoperative pain is often minimal, and patients are routinely discharged either the same day or the following day. Because of the minimally invasive manor in which these surgeries are performed, these patients are only routinely on pain medications for one to three weeks after surgery. Similarly in the lumber spine minimally invasive and less invasive techniques have been pioneered over the last twenty years. It is now routine that patients after a lumbar fusion go home within one or two days of surgery, and some can even be done as an outpatient. While each person will need a personalized treatment plan to determine what type of lumbar fusion is best, the advances in spine surgery have made this surgery much less painful than when it was performed years in the past.

Post-Op Spinal Fusion Surgery Recovery Process and Length 

After a spinal fusion, at least partial nerve pain relief is often either immediate, or happens within the first few weeks. While it does take up to a year for the nerves to completely heal, often with in a few weeks patients report dramatic improvement in their nerve pain. As mentioned previously, the elimination of neck and back pain is not reliable with surgery, but if it is going to improve, it often takes months and significant therapy.  The exact post operative course will vary depending on the location and the technique for the surgery; however, most cervical fusions either require a soft collar or no collar after surgery. Similarly, after a lumbar fusion, braces may be used for comfort, but are often not required. Similar to many surgeries, after surgery patients will have some minor restrictions for about a month, such as no heavy lifting or aggressive range of motion, but most of the restrictions are lifted between one and two months after surgery.

In conclusion, cervical and lumbar surgeries are safe and effective treatment options for patients with a pinched nerve and persistent nerve pain.