Aftermath of Spinal Fusion Surgery: Complications, Potential Side Effects, Treatments

Spinal fusion surgery is a very common procedure to alleviate pain and stabilize the spine. Those people who have chronic spinal conditions can undergo the surgery after, of course, medical consultation.

What is Spinal Fusion Surgery?

Spinal fusion is a surgical procedure in which two or more vertebrae are permanently joined together. The vertebrae are the small, interlocking bones of the spine. This is done to eliminate uncomfortable motion or restore spinal stability. Only after your doctor can establish the source of your discomfort will they offer spinal fusion surgery.

The procedure permanently joins the vertebrae in the spine, so there is no movement between them anymore. The bones are fused. This way, your spine stabilizes, and you no longer feel pain or pressure on the nerves.

This procedure can also correct the injuries that affect the spinal alignment.

Reasons You Should Have Spinal Fusion Surgery

Spinal fusion surgery is highly recommended for those patients who have scoliosis, herniated disc, or degenerative disc disease. It is also a viable solution in cases of fractures, spinal injuries, or spondylolisthesis.

Furthermore, spinal fusion may be recommended by your doctor to address the following conditions:

• Spinal Deformities: Spinal fusion can help address malformations in the spine, such as lateral curvature (scoliosis).
• Spinal Instability or Weakness: Your spine may become unstable if there is irregular or excessive mobility between two vertebrae. This is a frequent complication of severe spine arthritis. In such circumstances, spinal fusion may be done to restore spinal stability.
• Herniated Disc: After removing a damaged (herniated) disc, spinal fusion may be done to stabilize the spine.

How is Spinal Fusion Performed?

Surgeons execute spinal fusion surgery under anesthesia, so the patient is completely unaware of what’s going on. Various procedures for spinal fusion surgery have been devised using the latest techniques and technology. 

The surgeon’s procedure depends on the position of the fused vertebrae, the cause of the fusion, and, in some instances, your overall health and body form.

These are the steps of spinal fusion surgery:

Anesthesia

You will not be aware of or experience any discomfort throughout the spinal fusion operation since it is performed under general anesthesia. You’ll be lying down with a blood pressure cuff on your arm and a cardiac monitor on your chest during the treatment. 

This lets your surgeon and anesthesia provider keep an eye on your heartbeat and blood pressure while you are unconscious.

Bone Graft Preparation

A spine surgeon will use a bone graft to encourage bone fusion. They may use one type of bone graft or a combination of grafts. It is usually extracted from your pelvis, leg, or ribs. Local autograft is when the surgeon takes the bone from your spine.

Fusion

The surgeon inserts a bone graft between the vertebrae to fuse them permanently. At the same time, the bone graft sets, metal plates, rods, or screws may be used to keep the vertebrae together.

In certain circumstances, some surgeons use synthetic materials instead of bone transplants. These synthetic materials aid bone development and accelerate vertebral fusion.

Surgical Techniques and Materials 

There are several techniques and materials involved in spinal fusion surgery.

• Posterior Lumbar Interbody Fusion (PLIF): In this procedure, the axis is made through the back, and the vertebrae are fused.
• Anterior Lumbar Interbody Fusion (ALIF) is similar to the posterior lumbar interbody fusion, but the axis is made through the abdomen.
• Transforaminal Lumbar Interbody Fusion (TLIF) involves a combination of posterior and lateral approaches. The bone graft is taken from the patient or donor.

At times, synthetic options like plastic and ceramic are also used. There are also different instruments, like rods, plates, and screws, that may be used or placed in the spine to stabilize it and help in the healing.

What Happens After the Surgery

Spinal fusion surgery is mainly done to alleviate backache or neck pain,n which is due to instability or nerve compression.

Although the results vary per patient, most patients report significant relief within weeks and months following the procedure.  

Most patients report improved spine stability and mobility. Fusing the unstable spine segments provides strong structural support to the body, allowing patients to engage in daily activities without discomfort or needing pain relief pills.

Although the process may lose some flexibility, the stability and mobility that follow successful surgery compensate for this.

Remember the surgery takes 3-6 months to complete, and recovery can take up to a year.

Recovery From Surgery

Patients must stay in the hospital for a certain period of recuperation and supervision following a spinal fusion. This lasts 3-4 days on average. The doctor will first want to monitor the patient’s reactions to the anesthetic and operation. The patient’s discharge date is determined by their general health, the physician’s adopted procedures, and the patient’s response to the procedure.

Since their flexibility may be reduced after surgery, patients are taught new movement methods, including secure walking, standing, and sitting. Many patients may not be able to resume a typical solid food diet for a few days.

Patients frequently need to wear a back brace after leaving the hospital to keep their spine aligned. Patients typically cannot resume routine activities until the bone has fused into place. Fusing usually takes about 3 to 6 months. A patient’s age, overall health, and physical condition influence how soon they recuperate and return to normal activities.

Complications Following Spinal Fusion

In most cases, spinal fusion is a generally safe treatment. However, like any surgery, it comes with some risks. Before your treatment begins, your doctor will go through all of the procedure’s risks with you and take particular precautions to assist you in preventing any issues. The following are some of the potential dangers and problems of spinal fusion:

• Infection: Antibiotics are given to the patient before, during, and after the operation to reduce the risk of infection.
• Pain at the graft site: A small minority of patients will have ongoing discomfort at the location of the bone transplant.
• Bleeding: Although small bleeding is expected, it is rarely severe. BDonating blood before spinal fusion is typically not essential.  
• Recurring symptoms: Some people may experience a repeat of their initial symptoms. There are several reasons for this. If your initial symptoms return, tell your doctor so they can determine what’s causing them.
• Pseudarthrosis: When spinal fusion surgery fails, some patients may have no symptoms, while some have back, neck, arm, or leg discomfort.
• Nerve damage: Although it’s highly uncommon, it’s conceivable that these procedures will damage nerves or blood vessels.
• Blood clots: Another unusual consequence is the production of blood clots in the legs. They may become a serious threat if they break off and migrate to the lungs.

You must carefully follow your doctor’s recommendations regarding the warning signs of blood clots and infection. These issues will likely arise in the first few weeks following surgery.

A blood clot can move through the circulation and end up in the lungs on rare occasions. If this happens, you may have acute chest discomfort, shortness of breath, or coughing. Call your doctor immediately if you see any of these signs or symptoms.

Common Side Effects of Spinal Fusion Surgery

While, on the one hand, the surgery is quite successful in restoring the patient’s quality of life, it does come with its set of side effects. These side effects, as with any other surgery, can impact the mental health and physical well-being of the patient. 

It is important to be aware. Before you proceed with the surgery, talk to your healthcare provider about all these concerns.

Physical Side Effects

Some form of postoperative pain is kind of normal after the surgery. Usually, it is felt around the incision site and the muscles nearby. It can last for a few weeks but sometimes extends to months, depending on the body’s healing process.

At times, the tissues near the incision get surgical trauma, which is to blame, and at times, there’s inflammation or stress on the vertebrae, which are adapting to the fusion.

The pain can still be managed via medicines and ice packs. Light physical activity may also be recommended. 

Reduced Motion

Some specific parts of the spine are fused in the surgery, so those are permanently immobilized. This reduces the flexibility in the affected area, and patients may find it hard to bend or twist their bodies.

Decreased mobility may be due to the fused vertebrae, which can no longer move independently.

The doctor may recommend physical therapy to strengthen the surrounding tissues and muscles and improve mobility.

Muscle Spasms

Muscle spasms are the involuntary contractions and tightness you feel in the back muscles. These, too, are quite common after surgery and cause pain and discomfort.

The culprit is likely postsurgical inflammation, resulting from the muscles’ overcompensation close to the fusion site.

The physical therapist may advise stretching exercises to overcome the pain and use muscle relaxants and heat therapy to ease the muscles.

Psychological Side Effects

Apart from the physical side effects, some mental health issues could occur following the surgery. These include

• Depression or anxiety due to the emotional challenges of coping with recovery. 
• Emotional distress due to the pain
• Sleep disturbances due to the pain and discomfort

Strategies for Managing Side Effects

Here are some tips to manage the side effects of the surgery

• Use OTC drugs like acetaminophen or ibuprofen for pain
• Prescription opioids for short-term pain
• Cold packs
• Heat therapy
• Transcutaneous Electrical Nerve Stimulation (TENS)
• physiotherapy
• Mental health resources and support groups

Spinal Fusion Implant Failure

Spinal instrumentation, also known as spinal implants, devices, or hardware, involves surgical procedures that implant stainless steel, titanium, titanium alloy, or non-metallic items into the spine. It is a long-term remedy for spinal instability. 

Medical implants come in various forms, sizes, and styles. They are all meant to treat spinal diseases in individuals of all ages.

Instrumentation is utilized during spinal fusion to assist spinal stability and speed up the bone fusion process. These treatments restore spine stability, cure spinal deformities (such as scoliosis), and bridge space produced after a spinal decompression procedure by removing a spinal part.

An instrumented fusion might fail if there isn’t enough support to hold the spine as it fuses. As a result, spinal hardware might be utilized as an internal splint to keep the spine in place as it heals following surgery. However, it can get fatigued and shatter (sort of like when one bends a paper clip repeatedly).

Implant failure, particularly early after back surgery, is a sign of persistent severe spinal instability. The greater the patient’s size and the more fused segments, the greater the risk of implant failure.

Alternative Treatments to Spinal Fusion

Surgeries are often extremely painful and have a very long recovery time. Regenerative medicine provides an alternative to spinal fusion. It includes platelet-rich plasma (PRP) therapy and cell-based therapies. 

These treatments are non-invasive and less painful than conventional methods. At CELLAXYS, we offer two types of regenerative treatments.

Cell-based Therapies

This method includes extracting the patient’s healthy cells or “autologous” tissues, processing them, and reinjecting them into the injury site. The doctor takes these stem cells from the patient’s adipose (fat) tissue and bone marrow. 

Taking cells from the adipose tissue is called a Minimally Manipulated Adipose Tissue (MMAT) transplant. When they replace the highly concentrated cells from your bone marrow with the damaged cells, it is called Bone Marrow Concentrate (BMAC). 

Platelet-Rich Plasma (PRP) Therapy

It involves isolating platelets from the patient’s blood plasma, processing them, and returning them to the injury site. Platelets are the body’s first line of defense against injuries. They contain 10 Growth Factors to promote healing, send chemical signals to attract cells from the blood and produce a web-like structure called fibrin to support the development of new tissues. 

Cell-based and PRP therapies are outpatient procedures, meaning you can go home after the treatment. Cell-based therapies are completed within 1.5 to 2 hours, and PRP takes 45 minutes. The doctor used live imaging, such as X-rays or ultrasounds, to spot the exact location of the transplant. 

PRP and cell-based therapies are promising options for lumbar disc replacement and spinal fusion. These therapies can help with lower back discomfort while lowering the risks and recovery time associated with spinal fusion surgery.