Orthopedics / Neurology

Patient Education

Spinal Surgery

The lower back is a complex structure of vertebrae, disks, spinal cord, and nerves, including:

five bones called lumbar vertebrae- stacked one upon the other, connecting the upper spine to the pelvis.
six shock absorbers called disks- acting both as cushion and stabilizer to protect the lumbar vertebrae.
spinal cord and nerves- the "electric cables" which travel through a central canal in the lumbar vertebrae, connecting your brain to the muscles of your legs.
small joints- allowing functional movement and providing stability.
muscles and ligaments- providing strength and power and at the same time support and stability.
Frequently Asked Questions about Spinal Surgery

Spinal Fusion

Spinal fusion is a welding process by which two or more of the small bones (vertebrae) that make up the spinal column are fused together with bone grafts and internal devices such as metal rods to heal into a single solid bone. The surgery eliminates motion between vertebrae segments, which may be desirable when motion is the cause of significant pain.

Bone is the most commonly used material to help promote fusion. Generally, small pieces of bone are placed into the spaces between the vertebrae to be fused. Sometimes larger solid pieces of bone are used to provide immediate structural support. Bone may come from:

The patient (autogenous bone).
A bank of bone harvested from other individuals (allograft bone).

Autogenous bone is generally considered superior at promoting fusion. But drawbacks to using it include extra surgery to remove bone from patient's body such as the hip or pelvis. Allograft bone is available from bone banks. Other bone graft substitutes are being developed, but have yet to be proven as cost effective substitutes for autogenous bone graft for general use.

After the fusion procedure has been performed, the adjacent spinal segments are held immobile to allow fusion to progress. Immobilization is achieved through internal fixation devices or external bracing or casting. Both forms of immobilization may be necessary at times.

The fused spine must be kept in proper alignment. The patient will be taught how to move properly, reposition, sit, stand, and walk. While in bed, the patient will be instructed to turn frequently using a "log rolling" technique in which the entire body is moved as a unit, not twisting the spine. The patient may be discharged from the hospital with a back brace or cast. The family will be taught how to provide care at home.

Cervical Fusion

Fusing vertebrae in the cervical curve nay help ease neck and arm pain. Two or more vertebrae in your neck are fused. Cervical fusion is usually done through an incision in the front of the neck. It may sometimes be done through the back of the neck, or through both the front and the back. The surgery generally takes from 1-4 hours.

Anterior Lumbar Fusion

Fusing vertebrae in the lumbar curve may help ease the lower back and leg pain. Anterior Lumbar Fusion is done through an incision in your stomach area. Depending on how many vertebrae are fused, the surgery may take 3-8 hours.

Posterior Lumbar Fusion

Fusing vertebrae in the lumbar curve may help ease lower back and leg pain. Posterior lumbar fusion is done through an incision in your back. The graft is put between the vertebrae in one of two places: in the disk space or between the transverse processes. Depending on how many vertebrae are fused, the surgery may take 3-8 hours.

Fusing the Transverse Processes

Bone graft is packed between the transverse processes ("wings") on the sides of the vertebrae. Occasionally, other nearby parts of the vertebrae are fused as well.
To help keep your spine steady and promote fusion, extra support may be used.
The incision is closed with sutures or staples.

Fusing the Disk Space

The disk between the vertebrae is removed.
Bone graft is packed in the now-empty space between the vertebrae. In time, the graft and the bone around it grow into a solid unit.
To help keep your spine steady and promote fusion, extra support may be used.
The incision is then closed with sutures or staples.

Recovering in the Hospital

After the surgery, you will go to a post anesthesia unit. This is sometimes called the recovery room. You will stay there until you are fully awake, usually a few hours. Then you will go to your room on the orthopedic floor. With cervical fusion, you may go home the next day. With lumbar fusion, you may stay in the hospital 2-4 days.

In the Recovery Room

When you first wake up from surgery, you may feel groggy, thirsty, or cold. Your throat may feel sore. You may have tubes in your body to drain blood and fluid from your incision. You may also have a tube called a catheter to drain your bladder for a few days.

In Your Hospital Room

You will be encouraged to get up and walk. At first, you will need help and you may not get far. But walking helps keep your blood moving and your lungs clear of fluid.
Your IV gives you fluids and nutrition until you can eat on your own, usually within a few days.
You may wear special stockings or boots to prevent blood clots in your legs.
You may be given a neck collar or back brace. Wear this as your doctor instructs.
You may see a physical therapist, who will teach you how to protect your spine when you move.

Managing your Pain

Your nurse may give you your pain medication. Or you may have a PCA (patient- controlled analgesia) pump. This allows you to control your own medication. When you push a button, medication is pumped through an IV line. At first, you may feel some pain even with medication. This is very normal. But if you are very uncomfortable, tell your nurse.

Recovering at Home

If you have had neck surgery, recovery takes about 3 months. For lower back surgery, recovery takes about 6 months to a year. To help protect your healing spine during this time, follow the guidelines below:

Use pain medication as directed

You will be prescribed medication for pain. Don't wait for the pain to get bad before you take your pain medication. Take it as directed and on time.

See your Surgeon

Visits after surgery let your surgeon keep track of your healing. If your stitches or staples weren't taken out before you left the hospital, they may be removed at one of these visits.

Get Moving

The right kind of movement can help your recovery.

Take a few short walks each day. Increase your walking time as you heal.
If you feel more pain than usual after an activity, you may have overdone it. Take it a little easier for a few hours.
Ask your surgeon what activities to avoid. Also ask when you can return to work, driving, etc.
You may see a physical therapist who will teach you how to move after the surgery. He or she may also teach you exercises to help you heal.

Your surgery checklist:

Use the checklist below to remind yourself what to do before and after your fusion surgery. Have your healthcare provider check the ones that apply to you.

Before Surgery	After Surgery
Stop smoking.	Schedule a visit with the surgeon for ___days/weeks after surgery.
See your primary care doctor.	Wear your brace or collar as directed.
Arrange to donate your own blood.	Walk to strengthen your spine and promote fusion.
Stop taking aspirin and ibuprofen __ days/weeks before surgery.	Take your pain medication as directed.
Don't eat or drink after midnight the night before surgery.	Do not drive until your surgeon tells you that you can.