What to Expect from Spinal Fusion Surgery?

Lumbar fusion surgeries are the most common type of spinal fusions in the United States. Most of these involve 1-3 levels but can at times be much more extensive and involve the lower thoracic levels down to the sacrum. The most common type of the latter surgeries is a T10 to pelvis fusion for degenerative scoliosis and spinal stenosis . This type of surgery is necessary in some patients, but in most cases, it is avoidable. Therefore, if you are offered a T10 to pelvis or a fusion involving more than 3 levels, a second opinion is recommended. If the first opinion was from an orthopedic spine surgeon, obtaining a second opinion from a neurosurgeon is recommended. In the opposite situation, seeing an orthopedic spine surgeon may be more balanced.

For the more standard 1-3 level lumbar fusions, the recovery process depends on whether the case employs minimally invasive techniques or is done using a standard open exposure. This is important because minimally invasive surgery (MIS) techniques allow for much smaller exposures and consequently much less trauma to the underlying muscles and ligaments. In my practice, a MIS lumbar fusion patient typically goes home the following day. In comparison, a patient requiring an open surgery on average requires 3-5 days of hospitalization before discharge criteria is met. Once home, the MIS patient is asked to take it easy at home for 2 weeks and is expected to be off pain pills within this time frame. The open surgery patient often requires pain pills for 4-6 weeks in comparison. Overall, the MIS patient is expected to recover well enough to start light exercise 1-3 months following surgery. The open surgery patient reaches the same recovery level on average at 3-6 months.

These differences beg the question - why isn’t MIS techniques used in all lumbar fusions? The answer is that not all patients may be good candidates for these MIS techniques, and not all surgeons are equally comfortable using these newer techniques. The critics of MIS techniques also feel that the small exposure limits the efficacy of surgery and takes much longer compared to open techniques. This latter criticism can be valid depending on the surgeon-in-question’s experience level using MIS techniques.