Spinal fusion – if there is significant instability of the spine

What is a spinal fusion (fixation)?

The spinal fusion is a surgical fixation of spinal segments. It is considered a therapeutic measure when conservative treatments did not help. It is the last step in the therapy decision. In some cases stabilization is the best options especially when severe instability exists. Under general anesthesia, our physicians primarily fix unstable sections using titanium elements. After a few months the inserted vertebral blocks fuse with the surrounding tissue letting a natural stiffening begin.

By fixing vertebrae, we achieve a natural reconstruction, increasing the instability of the spine, pain is significantly alleviated, and the mobility is almost completely preserved. A spinal fusion can be done on different levels of the spine - the procedure is not limited to the lumbar spine, but can also be realized in the cervical spine, in the thoracic spine and in the sacroiliac joint.

When is the spinal fusion really necessary?

Spondylodesis is required in cases of instability of the spinal segments, such as in patients  with vertebral slippage (spondylolisthesis) and deformities (scoliosis and kyphosis). Spinal instability may also be due to spinal disc wear, malalignment, osteoarthritis, sports injury or accidents, inflammatory processes, after multiple spinal surgery, vertebral body fractures and spinal tumors. If conservative therapies do not give a long-term healing perspective, if neurological deficits are present or if there are risks of instability a spinal fusion could be the best therapy as standalone treatment or in combination with other surgical procedures.

Operation procedure – spinal fusion will restore the stability of your spine

Stiffening is a major operation that requires the surgeon's team to be extremely focused and precise. Not only because adjacent vertebral bodies are connected together in an extremely sensitive body area, but also because this operation is final - it cannot be repeated again and mistakes can hardly be corrected. The fixation is performed under general anesthesia. The patient should be placed prone if the procedure is to be performed from the back or supine if the spine is accessed through a cut in the left lower abdomen. In some cases - if the surgeon wants to act from both sides - the patient has to be turned over during the course of the operation. Of course we cannot explain every step of the surgery, but we would like to give you an insight into the course of the surgery. Our goal is to restore a stable spine to connect unstable vertebral bodies to adjacent ones. So we connect these vertebral bodies with screws and plates that stay in the body usually forever. If spinal canal stenosis is present, it will be initially enlarged. If bone fragments are present in the spinal canal they will be removed. In other words, before we start stiffening, the neural structures must have enough long lasting space. The bone meal we collect will be used later.

The vertebral joints are refreshed. In some cases, the affected disc is removed and replaced with a cage. Then the bone meal is implanted in the refreshed vertebral joints. Titanium elements (screws) are introduced by the pedicle - the area between the vertebral body and the vertebral arch - in the vertebral body and finally fixed with rods. If vertebral bodies themselves are extremely damaged (in cases with tumor, fracture or severe inflammation), these affected vertebral bodies will be removed (vertebrectomy) and replaced with an artificial vertebral body (vertebral body replacement). Now the final fusion of the vertebral bodies can begin.

Right after the operation

After 2 to 5 hours under general anesthesia, patients are monitored by trained personnel for several hours. The duration of the monitoring depends, among other things, on whether your surgeon has performed the surgical access from the front (ventral) or from the back (dorsal) or possibly from both sides. In any case, your health conditions will be monitored. Do not be surprised - you will wake up with a drainage tube. Your doctor has placed this in the surgical area before the final wound closure in order to let blood and wound fluid to drain off. Afterwards you will be transferred to your room.

Post-operative days

Patience is all you need!  After all, what you have behind you is a major intervention! This means: Be careful and follow all the instructions for the post-operative phase. For a better understanding: The spine consists of 26 vertebrae, 23 intervertebral discs and countless muscles, tendons and ligaments. In this framework, which we call the spine, and which keeps us upright and mobile, now a very specific, natural component has been exchanged and replaced with an implant. This changes the static - and therefore the body has to learn to handle it in the time after the procedure. So - you have to stay in hospital for 10-12 days and wear a bandage 3-6 months. It ensures that everything 'stays in place', giving extra support to the spine. About a week after discharge, you begin physiotherapy to strengthen your abdominal and back muscles, and learn to avoid false movements. You may not feel well at night, and during the day you should sit as little as possible. Your employer will have to do without you for about 3 to 6 months. Carrying and lifting heavy objects is completely prohibited at this stage, so if you are careful (and you will be) the bony adhesion with the implant will work well.

Advantages/Complications - a spinal fusion cannot be undone

Stiffening on some spinal segments does not mean immobility. With stiffening of the thoracic spine, the patients feel no restrictions in their movement, since the thoracic spine is anyway "immobile". Stiffening in the cervical spine causes minimal movement restrictions as the neck movements are more likely to occur between the skull and the first vertebra (C1-atlas). Flexibility in the area of ​​the lumbar spine is slightly reduced because of body flexion (flexion and antiflexion) tends to occur mainly in the hip joint. Possible restrictions could be avoided by back training and in collaboration with physiotherapists.

A spinal fusion is a definitive procedure, it cannot be reversed. By stabilizing one segment of the spinal column, the adjacent sections could be subjected to increased stress, which could lead to new complaints. The risks of rebleeding or inflammation after surgery is low and even rarer are neurological failures or problems with the implant itself.

One thing must be made clear: despite stiffening in the spine, spinal fusion improves the mobility of the back as the pain-related restriction of movement is eliminated. Expressed in numbers, the success rate of such stiffening operations is around 85-90 percent. Usually patients do not take painkiller after spinal fusion; at least he can reduce it significantly. After 3-6 months, he is fully able to work again, and in his free time activity, he has not, or hardly limits.

Dr. med. Munther Sabarini

Dr. med. Munther Sabarini
Specialist in Neurosurgery

The Avicenna Clinic in Berlin is always willing to help you

Since the year 2001, the Avicenna Clinic is based in Berlin. Our doctors have at least 25 years of international experience in their respective fields (neurosurgery, spinal surgery, anesthesia, and orthopedics).

If you have severe back pain, a herniated disc or a suspected herniation, please contact us using the following information:

Avicenna Clinic
Paulsborner Str. 2
10709 Berlin

Telephone: +49 30 236 08 30
Fax: +49 30 236 08 33 11
E-Mail: info@avicenna-klinik.de