Important Facts You Need to Know About Minimally Invasive Spinal Fusion

Back pain is an unfortunate issue that affects many people. It can range in intensity from a minor inconvenience to debilitating pain that makes it difficult to accomplish everyday tasks. About 16 million American adults experience chronic back pain, and it is the leading cause of missed work days. Fortunately, there are several treatments to alleviate back pain, and because of advances in technology, many are considered non-invasive. This generally means smaller incisions, less scarring, shorter hospital stays, and quicker recovery times for patients.

Spinal fusion, a procedure in which an orthopedic surgeon or neurosurgeon fuses together two or more vertebrae in the spine, is one of the many effective minimally invasive back surgery options, along with artificial disc replacement, spinal decompression, and microdiscectomy.

How It Works 

Depending on the cause of back pain, the surgeon will perform either direct lateral interbody fusion or transforaminal lumbar interbody fusion. The patient is placed under general anesthesia for both procedures, following which the surgeon makes one or more small incisions to access the affected vertebrae. They access the spine through the patient's side for a direct lateral interbody fusion and their back for a transforaminal lumbar interbody fusion.

Using specialized instruments and a camera that amplifies the surgical site on a monitor, the surgeon then carefully moves back muscles out of the way to find and remove the disk causing the pain. They then fuse either a bone graft, made with tissue from the patient's body or a deceased donor, or titanium in place of the removed disk. There are, however, some instances in which it's preferable to leave the disks in place and fuse the bone on each side.

The surgeon then closes the incisions with sutures or surgical staples. The entire procedure can take up to five hours, depending on the severity of the issue and the patient's circumstances.

Issues that May Require Spinal Fusion

A surgeon may recommend spinal fusion to address muscle weakness, pain, or numbness. However, in some cases, it may be preferable to perform traditional open surgery to correct these issues. There are many congenital and acquired conditions that can put unwanted pressure on the spinal cord or nearby nerves, disrupting pain signals and compressing vertebrae. These include scoliosis, lordosis (abnormal inward curvature of the lower spine), herniated disks, pinched nerves in the neck and lower back, spine fractures, and tumors that affect the spinal cord, nerves, bones, or soft tissue near the spine. 

Surgeons assess patients’ need for minimally invasive spinal fusion by performing diagnostics such as physical exams, x-rays, and MRI/CT scans.

Risks and Complications 

While minimally invasive procedures generally have less risk to patient health than traditional open surgeries, they can cause excessive bleeding, infection, or injury to nearby organs. Moreover, there are other specific spinal fusion risks that, while rare, can seriously impact quality of life. These include nerve pain, muscle weakness, reduced mobility, and paralysis.

Fewer than 10 percent of patients experience low back or neck pain after spinal fusion, although many of those who undergo successful surgery still notice sporadic pain in certain circumstances. They might also experience limited flexibility and range of motion and be at a greater risk of adjacent segment disease. When fused together, vertebrae can no longer move independently as they were intended. In some cases, this places added stress on the spine, causing the natural discs to break down quicker than they would otherwise.

Preparing for Surgery

To reduce the likelihood of complications during surgery, the surgeon performs a pre-surgery medical checkup to determine if the patient has any other issues, such as high blood pressure or poor kidney function. They also need to know all of the medications, supplements, and vitamins the patient is taking, and offer prescription changes if necessary. Patients are also required to abstain from all nicotine products (cigarettes, vaping, etc.) before and after surgery, as it can negatively affect the body's capacity to heal and rebuild bone tissue.

The surgeon will also provide direction on what the patient can eat and/or drink before the surgery and discuss blood transfusions options. Patients also meet with an anesthesiology team to talk about anesthesia options, and must sign an informed consent document to acknowledge they understand the benefits and risks of the surgery.

Recovery

Depending on the type of procedure and challenges associated with it, the patient may have to stay a few days in the hospital before returning home. They should also have someone living with them to look after them and handle otherwise simple tasks that may be difficult due to decreased mobility and lingering pain. In some cases, symptoms greatly decrease following surgery, while in others, pain gradually subsides.

Maintaining correct posture is a particularly important part of the recovery process. The surgeon will advise the patient on how to walk, sit, and stand, and may even suggest wearing a brace. Within a few weeks post-surgery, the patient can typically begin physical therapy to build strength and get back to regular activities.