Anterior Posterior Spinal Fusion

What you should know

• Spinal fusion is surgery to fuse (join) together one or more vertebrae (VER-tih-bray) in your spine. The spine is a row of bones (vertebrae) beginning at the back of your neck. It follows the middle line of your back, and ends at your buttocks (rear-end). Disks lie between the vertebrae. These disks act as a cushions between the vertebrae, and allow bending and rotating of your neck and back. There are three areas of the spine. These are cervical (SIR-vih-kull) (neck), thoracic (thor-AH-sik) (chest), and lumbar (low back). The cervical spine allows movement in all directions. The thoracic spine has much less movement and protects the heart and lungs. The lumbar spine allows mostly forward and backward bending movements.
  
  
• Spinal fusion surgery may be done on the cervical, thoracic or lumbar areas of your spine. In this surgery, bone grafts may be placed around your spine to stop that area of your spine from moving. Hardware such as plates, screws and cages may also be used. After a spinal fusion, you will need to follow activity guidelines and you may need to wear a brace. Recovery after spinal fusion may take months or even longer.

Why do I need spinal fusion surgery?

Spinal fusion may be done for the following conditions:

• Treatment of fractured vertebrae. A fracture may allow vertebrae to slip forward on top of each other. This condition is called spondylolisthesis (spon-dih-low-lis-THEE-sis).
  
  
• Correction of deformity, such as scoliosis. Scoliosis is an S-shaped curvature of the spine.
  
  
• Treatment of instability. This means there is abnormal or too much movement between two or more vertebrae.
  
  
• Treatment of some cervical disk herniations (pockets that extend out of the vertebrae). Removal of cervical vertebrae may be done at the same time as a spinal fusion.
  
  
• Painful spine condition. Spinal fusion may be done for pain with movement that is not controlled with medicine or other treatments.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Risks

• There are always risks with surgery. You may bleed more than usual or get an infection. Nerves in the area where the disc is removed could be injured. These problems are usually short-term, but may be permanent. If these problems happen, you may need to have more surgery. You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening.
  
  
• You could have numbness or pain along the nerve path causing problems like paralysis. You could be incontinent. This means you could have problems controlling your bowel or bladder. You could be impotent. This means a man may not be able to have an erection, or may not be able to make a baby. The dura (tough tissue covering the spinal cord) could be torn. This may cause fluid to leak out of the spinal cord. You may have to lie flat for a few days or may need surgery to sew up the hole in the dura. Without surgery, your back problems may get worse. Call your caregiver if you are worried or have questions about your medicine or care.

Getting Ready

Before Surgery:

• Ask your caregiver if you need to stop taking aspirin or any other blood thinning medicines before your procedure.
  
  
• Ask your caregiver before taking any over-the-counter medicine, vitamins, herbs, food supplements, or laxatives.
  
  
• You may need blood tests before your procedure. Talk to your caregiver about these or other tests you may need. Write down the date, time and location for each test.
  
  
• If caregivers think you may need a blood transfusion during surgery, you may be able to donate your own blood before surgery. This is called autologous (ah-TALL-uh-gus) blood donation. This must be done no later than several days before surgery. You may also ask a family member or friend with the same blood type to donate their blood. This is called directed blood donation. Talk to your caregiver for more information on autologous or directed blood donation.

The Night Before Surgery:

• You may be given a pill to take to help you sleep.
  
  
• Ask caregivers about directions for eating and drinking.

The Day Of Surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• Ask your caregiver before taking any medicine on the day of surgery. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring a list of your medicines or the pill bottles with you to the hospital.
  
  
• Do not wear contact lenses the day of surgery. You may wear your glasses.
  
  
• If you are staying in the hospital after surgery, bring your personal belongings (bathrobe, toothbrush, hairbrush) with you. Do not wear jewelry or bring money to the hospital.
  
  
• An anesthesiologist (an-iss-thee-z-ALL-o-jist) may talk to you before your surgery. This is the caregiver who gives you medicine to make you sleepy during surgery.
  
  
• Make sure you have signed an informed consent. You or a close family member may be asked to sign a legal piece of paper (consent form). It gives your caregiver permission to do your surgery. Be sure all your questions have been answered before you sign this form.

Treatment

What Will Happen:

• The goal of spinal fusion surgery is to strongly join two or more vertebrae. There are many different ways for doctors to do a spinal fusion, but all ways use bone grafts. Bone grafts are pieces of bone taken from another bone in your body (autograft) or from a bone bank (allograft). Man-made bone may also be used for bone grafts.
  
  
• You will be asked to change into a hospital gown. You may be given medicine in your IV to help you relax or make you drowsy. You will be taken on a cart to the operating room. You will be given medicine called general anesthesia (an-iss-THEE-zuh) to keep you completely asleep. A central IV catheter (KATH-uh-ter) may be put into a large vein under your collarbone or in your neck. The IV can be used to give medicines and to see how well your heart is doing during surgery.
  
  
• Sticky pads called evoked potential (po-TEN-shull) will be taped to your skin to watch your nerve activity. Your caregiver will clean your skin with soap and water. Sheets will be put over you. Incisions (cuts) will be made in the front, back or both sides of your body. These incisions will give caregivers access to your spine. Cervical spine fusion is usually operated on from the front. Thoracic and lumbar fusion surgeries are usually operated on from the back. If you have an autograft, one or more pieces of bone will be taken from another area of your body. Bone or artificial bone will be placed between the vertebrae. Metal plates, screws and cages may be placed to hold the vertebrae together while the bone grafts heal, or to help straighten the spine. The incisions will be closed with sutures (thread). Bandages will be put over the incisions. If you had an autograft, a bandage will also be placed over that area.

After Surgery:

You will be taken to the recovery room or an intensive care unit (ICU). Caregivers will watch you very closely. Bandages will cover your stitches. Do not get out of bed until your caregiver says it is OK. You may have either a cast or brace on after surgery.

Waiting Room:

This is a room where your family can wait until you are ready for visitors after surgery. Caregivers can find them in this room to let them know how your surgery went. If your family leaves the hospital, ask them to leave a phone number where they can be reached. When it is time for you to go home after surgery, someone should drive you home. Do not drive home alone. An adult should stay with you for at least 24 hours after surgery.

Contact a caregiver if

• You cannot make it to your surgery appointment on time.
  
  
• You have a fever.
  
  
• The problems for which you are having surgery get worse.
  
  
• You have questions or concerns about your surgery.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.