Spinal fusion surgery is connecting one spinal vertebrae to another spinal vertebrae. This is done through a bone “bridge”, that is bone is placed between the vertebrae. The bone is usually placed between the vertebral bodies. This is called an interbody fusion. If the fusion is done through your abdomen it is called anterior lumbar interbody fusion (ALIF), through your side/flank [Direct lateral interbody fusion (DLIF) or extreme lateral interbody fusion (XLIF)] or through your back [posterior lumbar interbody fusion (PLIF) or tranforaminal lumbar interbody fusion (TLIF)].
The surgical approach is important because it relates to pain, disability, muscle damage and complications. Fusions done through the back tend to be more painful resulting in greater recovery, time off and disability. This is appears less true for minimally invasive procedures like the endoscopic lumbar interbody fusion (ELIF). The more muscle damage the weaker the back and the higher chance of future spinal disease and pain.
There are complications related to anesthesia and surgery. All surgery has risks but the specific risk to fusion surgery is partially related to the approach to the spine:
1. Surgery done from the abdomen put major blood vessels (like the aorta and vena cava) and abdominal organs like kidneys at risk. There is even a chance for errectile dysfunction (E.D.) or retrograde ejaculation (sperm goes into the bladder not out the penis). These problems can lead to infertility.
2. Surgery from the side can injury the lumbar plexus (these are nerves that supply the legs) causing pain, numbness or weakness in the legs.
3. Surgery done through the back muscles can injure the muscles causing future pain and new spine problems. This muscle damage is decreased with minimally invasive surgery.
Most people have to wear a brace after surgery for 1 to 3 months, but it depends on the type of fusion and instrumentation surgery, number of levels fused and the reason for fusion.