A spinal fusion (also known as back fusion) is a surgical procedure that permanently joins together (fuse) two or more vertebrae (bones in the spine). Screws, plates, and cages are often used to fuse the vertebrae. After the procedure, there is no longer movement between the fused vertebrae.
Spinal fusion is often performed along with other surgical procedures (eg, foraminotomy, or laminectomy) to treat spinal disorders such as spinal stenosis. It may also be performed alone to fix spinal conditions such as abnormal curvatures, weak or unstable spine, and spinal fractures.
Spinal fusion is often performed in the cervical region (cervical fusion) and the lumbar region (lumbar fusion) of the spine.
To answer this question, we need to know what a successful spinal fusion means. Unfortunately, there are no agreed upon criteria that a fusion must meet for it to be considered successful.
Many physicians claim spinal fusion success rates (or back fusion success rates) as high as above 90 percent. But they don’t always explain what their criteria are for a successful fusion. So we don’t know if they mean the bones have been solidly fused together (technical success), or the patient’s symptoms have been satisfactorily improved (clinical success), or both.
Like any other types of surgery, the clinical outcome of a spinal fusion depends on not only the surgeon’s experience but also the diagnosis and the patient’s overall health condition. Therefore the clinical outcomes of spinal fusions vary from doctor to doctor, and from patient to patient. In addition, one physician’s lumbar spinal fusion success rate may be different from his or her cervical spinal fusion success rate.
So when you talk to a physician, not only ask about his or her overall spinal fusion success rate or back fusion success rate, but also ask him or her to explain what he or she means by a successful fusion. If you are seeking treatment for your lower back, you should also find out the physician’s lumbar fusion success rate.
Please keep in mind that even if a spinal fusion is considered successful by the surgeon, it does not mean that all the pain and associated discomfort will all vanish. It’s very possible that the patient will continue to experience certain degrees of pain and discomfort.
Spinal fusions are known to be associated with high rates of failed back surgery syndrome (FBSS) in which the old back pain persists and/or new pain emerges. Spinal fusion puts excess stress on the vertebrae above and below the fusion, which could cause additional problems later on. In addition, the hardware (screws, plates, and cages) used to fuse the vertebrae may cause infection or other problems to the spine.
A recent article published in Spine journal compared the long-term outcomes of lumbar treatment with or without fusion in a total of 1450 patients. At the end of the 2-year long study, the authors found out that compared with patients who did not undergo fusion, patients who underwent fusion had significantly high rates of disability, opiate use, and prolonged work loss, as well as low return-to-work status. On the basis of the result, the authors warned that lumbar fusion may not be an effective operation for spinal conditions such as disc degeneration, disc herniation, and/or radiculopathy.
The truth is spinal fusion may not be needed for some spinal conditions such as herniated discs. A number of studies have suggested that the clinical success rates of minimally invasive discectomy without fusion are similar to spinal fusion success rates, including lumbar fusion success rates, but the complication rates of minimally invasive surgery are much lower than those of traditional discectomy with fusion.
Dr. Marcello Sammarone, MD ●