Spinal Fusion Surgery: Everything You Need to Know

In This Article

Spinal fusion is a surgical procedure that links bones in the spinal column together to treat back problems such as herniated disks, fractures, or scoliosis. During the surgery, vertebrae are fused together to heal into a single solid bone, eliminating movement between them and relieving pain. 

X-ray of neck showing spinal fusion

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What Is Spinal Fusion Surgery?

The spinal column, or backbone, is made up of small, individual bones that are stacked together. Between each of these vertebrae is a soft cushion called a disk. It's this spacing of the vertebrae that allow each one to slightly bend, giving you the ability to bend forward, arch backward, and twist from side to side.

If there is a problem with vertebrae or disks, movement can become painful. Fusing two or more vertebrae together, via bone grafting, eliminates the motion that is causing pain.

Bone grafts can be done using bone from another part of the body (an autograft procedure), part of a vertebra removed for decompression (a local autograft), or bone harvested from a deceased donor (an allograft).

Artificial grafting materials are also available, including demineralized bone matrices (DBMs) from cadavers, synthetic bone morphogenetic proteins (BMPs), and synthetic bone.

Typically performed as a scheduled surgery in a hospital, there are several different techniques and approaches to spinal fusion. In fact, the surgery goes by many names, which are typically based on the part of the spine being operated on and the approach the surgeon takes to access it.

You may hear some of the following common terms:

  • Cervical: Involving the vertebrae in the neck or cervical spinal region
  • Thoracic: Involving the vertebrae in the mid-back or thoracic spinal region
  • Lumbar: Involving the vertebrae in the lower back or lumbar spinal region
  • Posterior: The surgery is approached through the back of the body.
  • Anterior: The surgery is approached through the front of the body.
  • Lateral: The surgery is approached through the side of the body.

Smaller fusion surgeries may be performed using minimally invasive laparoscopic techniques, but many spinal fusions require open surgery. The technique used depends on the location of the affected vertebrae and extent of work needed.

Contraindications

Spinal fusion surgery is typically performed as a last resort after other treatments have failed. There are no contraindications associated with the procedure.

Potential Risks

As with all surgeries, there are some risks associated with spinal fusion surgery, which include:

  • Infection in the wound or bones
  • Spinal nerve damage that can result in weakness, pain, loss of sensation, and loss of bowel or bladder control
  • The vertebrae above and below the fusion are more likely to wear away, leading to more problems later
  • Leakage of spinal fluid that may require more surgery
  • Headaches
  • Bleeding and blood clots
  • Reaction to anesthesia including breathing problems

Purpose of Spinal Fusion

The goal of spinal fusion surgery is to stimulate bone growth between two or more vertebrae using bone grafting. Once new bone forms, the vertebrae will be linked together, and there should be no further movement between the fused segments.

Several conditions are characterized by movement of vertebrae that causes back and/or neck pain. Examples of issues that may, therefore, be relieved by spinal fusion include:

The path from initial problems with the spine to spinal fusion surgery may be lengthy. With the exception of a fractured vertebra, surgery is not typically considered until other less-invasive treatments have proven ineffective. Medication and physical therapy are first-line treatments for back pain.

The decision to have spinal surgery is based on the history of symptoms, tests including magnetic resonance imaging (MRI), X-ray, and physical examination.

In some cases, the surgeon will not know if spinal fusion is required until opening the patient up to perform another procedure such as a diskectomy to remove a damaged disk between vertebrae, a laminectomy to remove part of the vertebrae (such as a bone spur), or a foraminotomy to widen the opening where nerve roots exit the spinal column.

How to Prepare

Spinal fusion surgery is almost always a scheduled procedure that requires a three- to four-night hospital stay. Depending on your current condition and the surgeon's availability, you may wait for weeks or even months for the surgery.

The surgical team will provide you with more detailed instructions on what you will need to do in the days and hours before surgery.

Location

Spinal fusion surgery is performed in a hospital operating room. Patients are usually asked to arrive at the hospital several hours before the scheduled procedure time; you will only learn your procedure time a day or two before your surgery.

You will not be allowed to drive upon hospital discharge, so you should arrange in advance for someone to bring you to the hospital and drive you home again.

What to Wear

The surgery will be performed while you are wearing a hospital gown, so you may want to wear something that is easy to change out of.

You will not be allowed to wear jewelry during the procedure and you should leave anything of value at home.

Food and Drink

Eating or drinking before surgery may cause problems when you are under anesthesia. It is typically recommended to stop eating and drinking eight hours before a surgical procedure. Follow the specific instructions provided in advance by the hospital.

Medications

Certain prescription and over-the-counter medications and supplements should not be taken prior to any surgery. These include:

  • Blood thinners: Aspirin, Plavix (clopidogrel), Coumarin (warfarin), heparin, and NSAIDs, such as Advil (ibuprofen) and Aleve (naproxen), can inhibit blood clotting, which could be problematic during surgery. 
  • Diabetes medications: People with diabetes who are taking blood-sugar-lowering medications such as insulin, metformin, Trulicity (dulaglutide), Jardiance (empagliflozin), Actos (pioglitazone), and Lantus (insulin glargine) may be advised to take a lower dose or skip the medication on the morning of the surgery because the surgery will be performed on an empty stomach. 
  • Antidepressants, anti-anxiety, and pain medications: Certain medications including Vicodin (hydrocodone), Ultram (tramadol), Percocet (oxycodone with acetaminophen), Lyrica (pregabalin), and Valium (diazepam) can alter the effectiveness of sedation, especially if you have been taking them longterm.
  • Marijuana and recreational drugs: Marijuana, nicotine, alcohol, and CBD products may your heart rate, blood pressure, and reaction to sedation during and after your procedure.
  • Supplements: Supplements to avoid prior to surgery include ginkgo biloba, vitamin E, feverfew, garlic, ginger, ginseng, omega-3 fatty acids, fish oil, St. John’s wort, and turmeric.

If you are taking any of these medications, talk to your doctor in advance to confirm if and when to stop taking them. Inform your surgical team of any prescription or over-the-counter medications or supplements you are taking. Be candid about your use of any recreational drugs, alcohol, and nicotine. And most importantly, follow all of your doctor's instructions to reduce your risk of complications.

What to Bring

Prepare what you will need the night before, so you are ready to go in the morning, especially if your surgery is scheduled for early in the day. Be prepared to spend at least two nights in the hospital. Items you will need or want:

  • Insurance documents and identification
  • An overnight bag with toiletries and toothbrush
  • An eye mask to wear while sleeping
  • Cell phone and charger
  • Earbuds or headphones to drown out hospital noises
  • Change of clothes
  • Comfort items, such as slippers
  • Book, magazine, or tablet

Pre-Op Lifestyle Changes

Following a healthy diet and getting regular physical activity before surgery can help you to recover more quickly afterward. Of course, it's best to ask your doctor what exercises are safe for you to perform.

If you are a smoker, quitting weeks before surgery can improve your odds of a successful procedure. The risk of spine fusion failure—the lack of a new bone forming—goes up about 500% in smokers. This is because smoking impedes new bone formation, which can have a detrimental effect on your recovery.

What to Expect on the Day of Surgery

On the day of your spinal fusion surgery, give yourself some extra time to park and navigate the hospital. Remember to bring your insurance documents and identification.

When you arrive at the facility, you will spend some time checking in, filling out consent and other forms, and verifying any insurance information.

Before the Procedure

You will be taken to a room to change into a hospital gown. At this point, you will be asked to update and review your medical history, answer questions about the last time you ate or drank, and undergo a brief physical examination. You will be connected to an IV for fluids and medications.

From here, you will be brought into the operating room, which will be set up with an operating table, surgical equipment, computers and screens, and other medical machinery. The operating room may be chilly, but you will have blankets to keep warm.

How you are placed on the table will depend on the type of procedure being done. An anterior approach may be used for procedures on the lumbar or surgical spine, in which case you will be placed on your back for the surgery. In a posterior approach surgery, you will be placed on your stomach.

The anesthesia provider will give you an IV sedative to help you relax. Then a breathing tube, or endotracheal tube, is threaded through the mouth and into the windpipe before being connected to a ventilator.

The breathing tube is necessary because general anesthesia causes temporary paralysis in addition to rendering the patient unconscious. During this time, the patient cannot breathe without assistance and depends upon the ventilator to supply air to the lungs.

The surgical staff will swab the skin in the area of the surgery with a solution that kills germs to help prevent infections along the incision. Once the skin is prepared for surgery, the staff will cover the patient with sterile drapes to keep the area as clean as possible during the operation.

During the Surgery

The surgery starts with an incision at the location of the damaged vertebrae. Before the fusion can begin, your surgeon will likely perform another procedure such as a diskectomy, laminectomy, or foraminotomy.

After that is complete, the surgeon will begin the bone grafting. Autograft procedures are traditionally done using a piece of bone from a part of the pelvis known as the iliac crest. If you are having this type, your surgeon will make an incision near your hip to harvest bone material to use in the spinal fusion.

As part of the process, your surgeon may use metal instruments such as plates, screws, and rods to help hold the vertebral bones together and keep the bones still. Known as internal fixation, this can increase the rate of successful healing and allow patients to move earlier after surgery.
When the procedure is complete, the surgeon will seal up the incision using either stitches or staples. The incision will be covered with a sterile bandage to protect the skin and prevent infection.

The surgery takes about three to four hours to complete, though it may be longer or shorter depending on the extent of repair work that needs to be done.

After the Surgery

Once the incision is covered, the anesthesia is stopped and you will slowly begin to wake. As the anesthesia wears off, the breathing tube is removed then you'll move to the recovery room for monitoring.

You can expect to be groggy at first, slowly becoming more alert. Your vital signs will be monitored closely for any possible complications, and pain medication will be given when necessary.

Once you are awake and your blood pressure, pulse, and breathing are stable, you will be moved to a hospital room to begin healing.

You can expect to stay in the hospital for several days following the surgery and will be given pain medicine either by mouth, IV, or through a pump that allows you to control how much medicine you receive (with limits).

You may not be able to eat solid foods for two to three days after the surgery, but you will be given nutrients through an IV and may be allowed to eat soft foods like soup or gelatin.

While in the hospital, you will receive physical and occupational therapy to help you get moving again. You will be advised on how to move to protect your back while you heal, such as using a "log-roll" technique to get out of bed to avoid twisting the spine. You may also be fitted for a back brace to use as you recover.

Some patients require additional support and may be discharged from the hospital to a rehabilitation facility or assigned a visiting nurse and physical therapist at home.

Recovery

Recovery following spinal fusion surgery can be slow and painful, and the length of time it can take to feel like yourself again depends on various factors including your age, health, and scope of the procedure performed. It may take longer to recover from a pelvic autograft procedure than one that uses a local autograft or allograft.

Older adults or those who have had more extensive procedures can take four to six months to recover. Younger patients may bounce back faster, but can still expect it to take four to six weeks to return to work at a desk job and even longer for physical labor.

Don't forget to make a post-surgical follow-up appointment in two to four weeks after your surgery, or as otherwise directed.

Activity

For the first two weeks after surgery you will need to limit trips up and down the stairs to once a day, take short walks, and not sit for more than 20 minutes at a time.

You will also not be allowed to drive until you are cleared by your doctor and should avoid car rides longer than 30 minutes without take a break to stretch your legs.

Avoid housework, carrying anything heavier than 10 pounds (including children), or lifting something over your head until your incision heals.

If you were fitted for a back brace or support following spinal fusion surgery, it is generally recommended that you wear it while sitting and walking, but it may not be necessary to wear it while sleeping, depending on your condition.

Once the bone fusion is healed, you will need to undergo physical therapy to strengthen back muscles and learn proper techniques to support the back. Your therapist will guide you to find a balance between not enough activity and too much of it.

Follow all of your medical team's instructions for resuming normal activity and exercise, including sexual activity.

Healing

You will need to keep the incision dry for for the first five to seven days and should be covered with plastic wrap when you bathe. The dressing will likely come off on its own after seven to 10 days.

It is normal for the incision to be red, numb, or sore as it heals, but watch closely for signs of infection. You should also watch for symptoms of blood clots: swelling in below the knee, tenderness or redness around the knee, and calf pain. Blood clots can be dangerous if they travel through the blood stream and settle into the lungs.

Pain Management

Recovery from spinal fusion surgery can be painful and you will likely leave the hospital with a prescription for opioid pain killers, such as OxyContin (oxycodone) or Percocet (oxycodone with acetaminophen).

While opioids are very effective pain relievers, they are addictive and should be used sparingly. Opioid side effects can also be significant and include nausea, vomiting, constipation, urinary retention, drowsiness, impaired thinking skills, and poor respiratory function.

Over-the-counter non-steroidal anti-inflammatory drugs such as Tylenol (acetaminophen) and Advil (ibuprofen) can also be used to treat post-surgical pain. Many doctors recommend alternating dosing between the two. However, Percocet also contains acetaminophen and should not be taken with Tylenol as liver damage can occur.

When to Call Your Doctor

If you experience any of the following symptoms call your doctor:

  • Chills or a fever of 101 degrees F or higher
  • More pain in the area that was operated on
  • Incision is warm to the touch with more redness and swelling
  • Drainage from the incision, especially if the drainage is green, yellow, or foul smelling
  • Loss of feeling or a change of feeling in your arms (if you had neck surgery) or your legs and feet (if you had lower back surgery)
  • Swelling in the legs
  • Calf pain
  • Back pain that worsens and does not get better with rest and pain medicine
  • Difficulty urinating and controlling your bowel movements

Call 911 or head to the emergency room if you experience chest pain or shortness of breath, as this may be a sign that a blood clot has traveled to the lungs.

Long-Term Care

Taking care of your body will go a long way toward relieving your back pain in the long run. It is important to make sure you complete your full course of physical therapy and practice safe movement techniques, such as bending your knees to lift heavy objects and not overdoing it.

Following a healthy diet, getting regular exercise (including daily stretching exercises), maintaining a healthy weight, and avoiding smoking and tobacco products are essential for healing from back surgery and keeping back pain at bay long term.

A Word From Verywell

Spinal fusion surgery can be very effective in treating chronic back pain after other treatments have failed. However, it does not always work for everyone and, in some cases, can make pain worse. Following your doctor and therapist's instructions on proper post-surgical care can increase your chances of having a successful procedure outcome.

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Article Sources
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