There are many surgical approaches and methods available to fuse the spine, and they all involve placement of a bone graft between the vertebrae. The spine may be approached and the graft placed either from the back or from the front or by a combination of both.
The ultimate goal of spinal fusion is to achieve a solid union between two or more vertebrae. A spinal fusion may or may not involve use of hardware such as plates, screws and cages. This use of hardware is sometimes used to correct a deformity, but usually is used as an internal splint to hold the vertebrae together to while the bone grafts heal.
Whether or not hardware is used, it is important that bone or bone substitutes be used to get the vertebrae to fuse together. The bone may be taken either from another bone in the patient (autograft) or from a bone bank (allograft). Fusion using bone taken from the patient has a long history of use and results in predictable healing. Although healing and fusion is not as predictable as with the patient’s own bone, allograft does not require a separate incision to take the patient’s own bone for grafting, and therefore is associated with less pain. Smoking, medications you are taking for other conditions, and your overall health can affect the rate of healing and fusion, too.
With some of the newer “minimally invasive” surgical techniques currently available, fusion may sometimes be done through smaller incisions. The indications for minimally invasive surgery (MIS) are identical to those for traditional large incision surgery; however, it is important to realize that a smaller incision does not necessarily mean less risk involved in the surgery.
Recovery following fusion surgery is generally longer than for other types of spinal surgery. Patients generally stay in the hospital for three or four days, but a longer stay after more extensive surgery is not uncommon. A short stay in a rehabilitation unit after release from the hospital is often recommended for patients who had extensive surgery, or for elderly or debilitated patients.
The length of time required you must be off of work will depend upon both the type of surgery and the kind of job you have. It can vary anywhere from approximately four to six weeks for a single level fusion in a young, healthy patient with a sedentary job to as much as four to six months for more extensive surgery in an older patient with a more physically demanding occupation.