What is it?
To join adjacent vertebra together so that they cannot move. It involves inserting some form of fixation – spinal screws, plates and rods, or cages – and some form of graft material so that the bones grow together.
It is the fusing of the bones that ensures the long-term success of the surgery.
The bones graft material is normally harvested from the same person e.g. the pelvis or the same site as the surgery.
There is also manufactured material that can be bought, and occasionally donor bone can be used as graft material.
Why is it used?
Spinal fusion surgery is performed because of acute pain in the back and / or the nerves. It alleviates those symptoms and can lead to a better quality of life.
Inevitably the joints between bones degenerate. It is part of the ageing process. This sometimes leads to instability of joints, resulting in pain.
Spinal fusion can successfully address those symptoms. However, success of the surgery depends on the exact underlying disease process.
The surgeon’s diagnosis is critical in assessing that. How much time does the surgeon take? And how thorough is their diagnosis? These are critical questions a patient must bear in mind.
Two unstable and adjacent vertebrae can cause significant nerve impingement and pain in the legs. Spinal Fusion for that is reliable and will provide pain relief.
However, a degenerative change in an intervertebral disc may cause back pain. In this instance fusion surgery will have limited success and has a high failure rate in relieving back pain.
It may be better to explore non-operative treatments to stabilise the spine and other forms of pain relief.
Which therefore comes back to the diagnosis.
Unstable nerve entrapment will have very high prospects of pain relief from spinal fusion.
An MRI showing some degeneration of the intervertebral disc is not specific enough. There are plenty of people with that condition who do not feel any pain. There may well be other causes of back pain.
And we always remember the impact of psycho-social factors that can amplify patients’ felt experiences of pain.
Many spinal fusion surgeries fail to alleviate the apparent pain symptoms. All that has happened is that the patient has been exposed to unnecessary expense and risk. There is compelling research to validate this caution.*
I do fuse patients’ spines, but only if it’s in the patient’s best interest and the diagnosis warrants it.
* Lumbar Spine Fusion: What is the Evidence Intern Medical Journal 2018 Dec Harris; Traeger; Stanford; Maher; Buchbinder
As always if you have any questions about a patient, please feel free to call me on 02 9650 4893. I will return your call and discuss how we can help.
You can also reach me via firstname.lastname@example.org.
Resources for Referrers
Further Resources available include:
- Why I only operate on 17% of my patients
- The limited role of cortisone injections for spinal conditions
- Lumbar Radiculopathy – and conditions that mimic it
- Cervical myelopathy – a disease of the spinal cord that may pass unnoticed
- Vertebroplasty – worth a rethink
- Management Regime for Lumbar Disc Herniation & Sciatica
- Why your patients might be struggling to walk (Lumbar Canal Stenosis)
- Cervical Radiculopathy – shooting pains from the neck
- Adult Spinal Deformities: Symptoms & Treatments
- Back pain and how to manage it
Dr Ralph Stanford is a spinal surgeon with over 20 years’ experience. He is adept in all surgical approaches to successfully treat his patients.
Dedicated to lifelong learning and sharing his expertise with others, Ralph attends spinal conferences worldwide and regularly consults with colleagues about successful treatments.
As a teacher Dr Ralph Stanford is Conjoint Senior Lecturer at the University of New South Wales; Supervisor of Training for Orthopaedic Trainees, Prince of Wales Hospital; and Education Secretary for the Spine Society of Australia.
As a researcher and scientist, he is a well-published author and Honorary Senior Scientist at Neuroscience Research Australia (NeuRA). He is also a current member of Spinal PFET.
Posted 17 May 2021
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