A spinal fusion is done as a treatment for back pain caused by motion such as degenerative disk disease, scoliosis, stenosis, spondylolisthesis, tumour, spine infection or a fracture. By fusing two or more bones in the spine, the motion between vertebrae is limited and discomfort caused by nearby nerves, muscles and ligaments are reduced. If you have pain in your leg or arm in addition to back pain, Dr Khumalo may suggest spinal decompression surgery prior to spinal fusion to remove tissue that may be causing pressure on the spinal nerves. While a spinal fusion will limit the range of movement, it is usually fused at one specific point in the spine and will only affect flexibility in some positions.
Depending on the area in which the pain is located, Dr Khumalo will either perform an anterior lumbar interbody fusion (through the abdomen) or a posterior fusion (approached from the back). Your orthopaedic surgeon will then make an incision to expose the laminae of the spine in order to perform a spinal decompression if necessary.
In order to fuse the vertebrae, small pieces of bone are placed into the space between the vertebrae to promote fusion and stimulate bone healing. This is called bone grafting. A bone graft may be harvested from the patient's pelvis or from the site of decompression if this procedure was done; otherwise, an artificial bone graft is used. After bone grafting, the vertebrae are held in place by rods or screws to give stability.
Although this is regarded as an invasive surgery, your spine will be stable immediately after surgery. Dr Khumalo will prescribe you pain medications to relieve any pain and discomfort. These medications may inhibit the function of your bladder, and thus a catheter may be needed for the first two days after surgery. You should be able to go home after two or three days depending on whether or not a spinal decompression was done in conjunction with the spinal fusion. Before you are discharged, a spinal x-ray will be done to see how the fusion is healing.
If a spinal decompression was done, your nerves, muscles and tissues would adapt to having the pressure removed. If only a spinal fusion was done, recovery might take up to 6 months before you can feel the difference. After surgery, you will have sessions with a physiotherapist and occupational therapist to aid you in walking and getting out of bed. Physiotherapy will be advised to help regain strength and mobility for the next few months. During recovery, you may be as active as your pain allows you, but you will be advised to avoid heavy lifting, vigorous exercise as well as twisting and bending for at least 6 months. You may return to work after 6 weeks of recovery. Recovery will require commitment, and you will see Dr Khumalo for regular check-ups in the next year or two.