Spinal fusion is a surgical procedure where two or more vertebrae in the spine are permanently joined together. This procedure is usually recommended when other treatments, such as chiropractic, physical therapy, and medications, have not provided sufficient relief from chronic pain or instability. A person may need spinal fusion for several reasons, including degenerative disc disease, significant spinal instability, protruding discs, scoliosis, spinal stenosis, trauma, or infections/diseases.
While a spinal fusion may be recommended, it is the opinion of most physicians that it should be a last resort – as in ALL other options should be exhausted. The typical dogma for spinal surgery is over-the-counter medications, conservative care (e.g. chiropractic care and physical therapy), steroids, steroid injections, and finally surgical intervention. Further, re-assessing diet and supplementation, augmenting physical activity, and working with a personal trainer that is specialized in functional movement patterns and increasing strength and stability should also be explored. Again, surgery should be a last resort after ALL other forms of care have been exhausted and failed.
There are significant risks with any surgery. In particular, a spinal fusion can lead to faster degeneration of other spinal segments of the spine leading to further surgeries and complications. This is why:
Increased Load on Adjacent Segments: When a spinal fusion is performed, two or more vertebrae are permanently joined together. This eliminates motion in the fused segment, causing the adjacent vertebrae to bear more load and stress during movement. Over time, this increased stress can lead to accelerated wear and tear of the nearby discs and joints, making them more prone to degeneration.
Altered Biomechanics: The fusion changes the natural motion and alignment of the spine. The spine is designed to have specific ranges of motion in different segments. When one part of the spine is fused, the adjacent segments may have to compensate for the lost motion. This altered biomechanics, or "compensatory motion," can result in abnormal stress patterns, leading to early degeneration of the discs, joints, and ligaments of the adjacent spinal segments.
Joint Instability: Fusing one segment can cause an imbalance in the spinal structure, leading to increased movement and stress on neighboring segments that are not fused. This added instability can result in accelerated degenerative changes in the affected areas.
Changes in Spinal Curvature: Spinal fusion can affect the overall curvature and alignment of the spine. If the spine's natural curvature is disrupted, the adjacent segments may have to adjust to accommodate this new alignment. Over time, these compensatory adjustments can result in more wear on the adjacent spinal segments, accelerating degeneration.
Disruption of Natural Spinal Motion: Each segment of the spine has a specific role in facilitating motion and distributing forces. Fusing a segment reduces the overall flexibility of the spine, and the forces that were once spread over multiple vertebrae may now be concentrated on fewer segments. This added force can lead to an earlier breakdown in the adjacent joints and discs.
These combined factors contribute to the quicker degeneration of the segments next to a spinal fusion. It's why some patients may experience symptoms such as pain, stiffness, or reduced mobility in areas of the spine adjacent to the fused section over time. It is very common that within 5-10 years of a spinal fusion, the spinal segment directly above (and sometimes below) will become degenerated and unstable to the point that it will need to be fused as well.
Note: Surgical intervention is a miracle of modern science and medicine. Surgical interventions have saved countless lives, both literally and in terms of overall vitality, quality, and functionality. This article is absolutely not to dissuade surgery, only to inform the reader. A decision to undergo surgical intervention should be maintained between the patient, the patient’s closest family/friends, primary care physicians, and surgeons. Surgical intervention may absolutely be the best option in some cases and should be performed if and when necessary.
Dr. Lewis Blevins
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