Spinal fusion, also called spinal fixation, is an operation in which one or more spinal levels are joined so they heal into a single block of bone. A bone graft or a cage is placed between the vertebrae so bone can grow through it, and screws and rods hold the level still until union is complete. The end result is that motion at the treated level stops, and that is the purpose of the operation rather than a side effect of it. Stopping motion is intended to treat instability or deformity, not appearance: slippage of one vertebra on another, excessive movement between two vertebrae causing pain and recurring nerve symptoms, a deformity such as scoliosis or kyphosis, an unstable fracture, a tumour or infection that has destroyed bone, or the situation following wide decompression of the spinal canal that removed the structures maintaining stability. Not every case of back pain is therefore a candidate, and back pain alone with near-normal imaging is not sufficient reason to fuse. The limits should be clear before you consent. Fusion does not regenerate a disc or make a vertebra young again; it exchanges painful unstable motion for stability. It does not treat pain arising from muscles, peripheral nerves or non-mechanical causes. It does not prevent degeneration of the adjacent levels and may increase the load they carry over time. And it does not guarantee freedom from all pain, particularly where pain has been chronic for years or long-standing nerve compression has already damaged the nerve. Successful union also depends on factors under your control. Smoking is one of the strongest inhibitors of bone healing and you will be asked to stop before and after surgery. Controlling diabetes, correcting vitamin D deficiency and poor nutrition, treating osteoporosis if present, and committing to the rehabilitation programme all matter. Bone union is a slow biological process that takes months and does not end when you leave hospital. Whether fusion suits you is determined by clinical examination together with standing, flexion and extension X-rays and MRI, and by matching your symptoms to the suspected level, not by reading a page or by an imaging report alone. You are entitled to ask about the alternative of decompression without fusion.
Procedure steps
- 1
Identifying the unstable level
The neurological examination is combined with standing, flexion and extension X-rays that reveal excessive movement or slippage, and with MRI showing nerve compression and disc condition, to confirm that the symptoms match the level proposed for fusion.
- 2
Preparation, anaesthesia and positioning
Under general anaesthesia the patient is positioned carefully to protect the eyes and peripheral nerves, the level is confirmed radiographically before the incision, electrical nerve monitoring is used where indicated, and infection and clot prevention measures are applied.
- 3
Decompression, disc removal and cage placement
The surgeon frees the compressed nerves by removing the offending bone, ligament or disc tissue, then clears the space between the vertebrae and inserts a cage or bone graft that acts as a scaffold through which bone grows while maintaining disc height and natural alignment.
- 4
Screws, rods and radiographic confirmation
Screws are placed in the vertebrae and connected by rods that prevent movement until union is achieved, sometimes inserted percutaneously in minimally invasive techniques. The position of every screw is verified radiographically during the operation before closure, and the wound is irrigated and closed in layers.
- 5
Early mobilisation and monitoring union
Standing and walking usually begin on the first day, with training to get up by rolling the body as one unit, while bending, twisting and lifting are restricted for as long as the surgeon specifies. Imaging is repeated at intervals to follow union, which takes months, and rehabilitation progresses alongside it.
Before the procedure
Stop smoking several weeks before the operation and stay off it afterwards, because it is the strongest factor working against bone union and raises the risk of failed fusion. Bring blood sugar and blood pressure under control, correct vitamin D or iron deficiency if asked, and start osteoporosis treatment if it has been diagnosed. List every medicine and supplement, especially blood thinners, aspirin, steroids and immune-modifying drugs, and stop nothing except on your doctor's instruction. Treat any active dental, urinary or skin infection before surgery. Complete blood tests and heart and lung assessment, and follow the fasting and pre-operative washing instructions. Prepare your home: a bed that is easy to get out of, a shower chair, and someone to help you for the first two weeks.
After the procedure
Get up by rolling your body as one unit rather than bending at the waist, take short frequent walks and increase them daily, and sleep on your back or side with a pillow supporting your position. Avoid bending, twisting and lifting anything heavier than the limit your surgeon set during the first weeks, and do not drive until you are cleared. Keep the wound clean and dry, wear the brace if one was prescribed, and follow the rehabilitation programme. Do not go back to smoking: union continues for months after discharge and needs healthy bone and good nutrition. **Go to the emergency department immediately for progressive weakness in the legs or feet, numbness between the thighs and around the anus, urinary retention, or leakage of urine or stool — these are cauda equina symptoms and are treated as a surgical emergency.** Contact your doctor quickly for fever or chills, fluid or pus from the wound, a severe headache that worsens on standing along with clear fluid leakage, pain and swelling in the calf, or chest pain and breathlessness.
Expected duration
The operation usually takes two to five hours depending on the number of levels, with a stay of about 2 to 5 days and bone union usually taking 3 to 12 months.
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