Doctor discussing spine x-rays with patient
Doctor discussing spine x-rays with patient
Doctor discussing spine x-rays with patient

Minimally Invasive Spinal Fusion

What is minimally invasive spinal fusion?

Spinal fusion is a surgical procedure to join 2 or more bones of your spine together permanently. A minimally invasive spinal fusion uses a smaller cut (incision) than a traditional spinal fusion surgery.

Your vertebrae are the small bones that make up your spinal column. These vertebrae stack on top of each other, separated by intervertebral discs. These bones protect your delicate spinal cord, which sends and receives information from your brain to the rest of your body.

Various medical conditions might cause your vertebrae to move against each other more than they should. This can stretch your surrounding nerves, ligaments, and muscles, causing pain. For example, if you have arthritis of your spine, your vertebrae might hurt when they move against each other. Spinal fusion may stop this pain by preventing 1 or more of your vertebrae from moving.

Depending on your problem, your surgeon might use different approaches to get to your vertebrae. For example, with direct lateral interbody fusion, your surgeon accesses your vertebrae from your side. With transforaminal lumbar interbody fusion, your surgeon approaches your spine through your back. Your surgeon then places a graft of some sort (like bone) in the space between your vertebrae.

For minimally invasive spinal fusion, you’ll be given medicine (general anesthesia) to put you asleep. A small incision will be made to access your spine. Your surgeon will gently push away the muscles of your back with a special tool. Your surgeon will then weld together 2 or more of your vertebrae, using bone or some other artificial material.

Minimally invasive spinal fusion uses a smaller incision than traditional surgery. It also doesn’t cut away the muscles of your spine. Because of this, it may lead to faster recovery times than traditional surgery. It may also reduce the chance for certain problems.

Why might I need minimally invasive spinal fusion?

You might need spinal fusion for a variety of medical conditions, including:

  • Degenerative disc disease
  • Spinal stenosis
  • Spondylolisthesis
  • Scoliosis
  • Break (fracture) of your spinal column
  • Infection of your spinal column
  • Tumor in your spinal column

These conditions might be causing you significant back pain. Your healthcare provider may want to try other more conservative treatments first, such as pain medicines and physical therapy. If these don’t work for you, minimally invasive spinal fusion may make sense. But spinal fusion can’t help all types of back pain. Your healthcare provider will recommend it, only if the procedure might work for you.

Talk with your healthcare provider about the risks and benefits of a minimally invasive spinal fusion, instead of a traditional one.

Spine Surgery Q&A with Hamid Hassanzadeh, M.D.

What are the risks of minimally invasive spinal fusion?

Most people do very well with their minimally invasive spinal fusion. But as with any surgery, the procedure does carry some risks. Possible complications of minimally invasive spinal fusion include:

  • Infection
  • Too much bleeding
  • Lack of a solid bone fusion
  • Nerve damage
  • Blood clots

There is also a risk that your surgery will not effectively get rid of your pain, or that the surgery might cause a different type of persistent pain at the graft site.

One side effect of all spinal fusion surgeries is decreased flexibility of your spine. Usually, this limits motion only a small amount and isn’t a major problem.

Your own risk for complications may vary according to your age, the surgical approach, the anatomy of your back problem, and your other medical conditions. Ask your healthcare provider about the risks that most apply to you.

How do I get ready for minimally invasive spinal fusion?

Ask your healthcare provider how you should prepare for your surgery. Ask if you should stop taking any medicines ahead of time, like blood thinners. If you are a smoker, you should try to quit before your surgery. You’ll need to avoid eating or drinking after the midnight before your procedure. Your healthcare provider may order additional imaging of your spine before your surgery, such as an MRI.

What happens during minimally invasive spinal fusion?

Your healthcare provider can help explain the details of your particular surgery. They will depend on the nature of your injury and the surgical approach. An orthopedic surgeon and a team of specialized nurses will perform the surgery. The whole surgery may take a couple of hours. In general, you can expect the following:

  1. You will be given anesthesia so that you’ll sleep and won’t feel any pain or discomfort during the surgery.
  2. Your vital signs, like your heart rate and blood pressure, will be carefully watched during the surgery. You may have a breathing tube inserted down your throat during the surgery to help you breathe.
  3. You may be given antibiotics during and after the procedure, to help prevent infection.
  4. Your surgeon will make a small incision, usually on your side or back.
  5. Using special tools, he or she will dilate your back muscles, pushing them out of the way.
  6. Your surgeon will remove the intervertebral disc between your affected vertebrae.
  7. He or she will place some sort of material in the space between your vertebrae. This might be bone or a synthetic bone-like material.
  8. Your surgeon may use special screws or other material to anchor your bones in place.
  9. Your surgeon will make other repairs, if needed.
  10. The layers of skin around your incision will be surgically closed.

What happens after minimally invasive spinal fusion?

Talk with your healthcare provider about what you can expect after surgery. You may have some pain around your incision after the procedure, but you can take pain medicines to relieve it. You should be able to resume your normal diet and activities fairly quickly. You may have some sort of imaging procedures, like X-ray, done to see how your surgery went. Depending on the extent of your injury and your other medical conditions, you might be able to go home within the next couple of days.

Your original symptoms may greatly decrease immediately after your surgery, or they might go away more slowly.

Follow all your healthcare provider’s instructions carefully. He or she might not want you to take certain over-the-counter medicines for pain. Some of these can interfere with bone healing. Your healthcare provider may advise you to eat a diet high in calcium and vitamin D as your bone heals.

You might have a little drainage from your incision. This is normal. Let your healthcare provider know right away if you notice an increase in redness, swelling, or draining from your incision. You should also let him or her know if you have high fever or severe pain that is not improving. Make sure to keep all of your follow-up appointments. You may need to have your stitches removed a week or so after your surgery.

While you heal, it’s important to keep your spine in proper alignment. A healthcare provider will show you the proper way to move. At first, you’ll probably need to only do light activity, like walking. As you heal, you’ll be able to slowly increase your activity level.

Next steps

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • What results to expect and what they mean
  • The risks and benefits of the test or procedure
  • What the possible side effects or complications are
  • When and where you are to have the test or procedure
  • Who will do the test or procedure and what that person’s qualifications are
  • What would happen if you did not have the test or procedure
  • Any alternative tests or procedures to think about
  • When and how will you get the results
  • Who to call after the test or procedure if you have questions or problems
  • How much will you have to pay for the test or procedure

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