Making choices on what treatments you seek for your health can be overwhelming if you don’t have the right information. This is especially the case if you’re faced with deciding between surgical or non-surgical treatment options. If your surgeon has recommended you undergo spinal fusion surgery for a herniated disc, you may have a lot of questions — is this the right surgery for my condition? What exactly is a spinal fusion? What does it entail? How long is the recovery time? What are the risks and benefits? Luckily, with the right information, you can make the best decisions for you and your lifestyle. In short, for the typical herniated disc a spinal fusion is not recommended. The vast majority of patients will not need surgery for herniated discs and can be treated with a much more conservative approach.
A Quick Explanation of a Herniated Disc
A herniated disc develops from what is known as the intervertebral discs of your spine. Your backbone is made up of 33 individual bones known as vertebrae that fit together, one on top of the other. These bones are uniquely shaped with a hole in the center, creating a space called the spinal canal which allows for your spinal cord and nerves to run the length of your back, from the base of your skull down. In addition, channels, or portholes, are created through the connection of these bones that allow your nerves to exit the spinal canal and travel to the rest of your body, known as the spinal foramen. To protect these bones from wear and tear and provide flexibility for twisting and bending, there are rubbery discs that sit in each space between the vertebrae. The outer layer of your discs is made up of a tough, fibrous yet flexible tissue, known as the annulus fibrosus. The inner portion is a gel-like substance, known as the nucleus pulposus. When a disc ruptures or herniates, the outer casing tears or cracks open. The inner contents of the disc can then push out into the spinal canal or foramen. In turn, this may place pressure on your spinal cord or nerve roots, creating inflammation, and causing symptoms that can include pain, tingling, numbness, or weakness.
What is a Spinal Fusion?
A spinal fusion surgery essentially takes two or more vertebra and grafts them together to form a solid column of bone. It is particularly useful when there are stability issues that put the spine at risk of fracture or failure. It may not, however, be the best choice to treat a ruptured disc.
While fusions in the past were regularly performed via a large incision, or an “open surgery”, advances in technology and technique have made it possible for spinal fusions to be performed through less invasive techniques under general anesthesia. This means that surgeons make small incisions near the affected vertebrae. Special instruments are used to access the surgical site through these incisions. This decreases the degree of muscle disruption that can result in increased postoperative pain and lengthy recovery times. The fusion surgery itself involves implantation of bone grafts and instrumentation, such as screws and rods, to span the space between two or more vertebra. As the grafts heal, a solid column of bone develops that provides stability to that portion of the spine.
Recovery from spinal fusion surgery is also a good deal longer in comparison to surgery directed specifically to address a herniated disc, such as microdiscectomy. In general, the risks are also higher; infection and potential graft failure are among the major concerns associated with a spinal fusion.
Is Spinal Fusion Really the Best Choice?
Many patients suffering from a herniated disc will never need an operation. However, if they cannot control their symptoms through conservative care or experience increasing neurological deficits, defined as loss of strength or sensation, surgery can be very effective. The vast majority of patients requiring surgery, however, will not need a fusion. Very rarely, patients may require a fusion if the herniated disc is also associated with significant spinal instability.
A spinal fusion does little to decompress the nerves affected by a ruptured disc. Its intended use is to stabilize the spine, but this comes at a price. A spinal fusion can compromise flexibility and mobility, as the portion of the spine that has been grafted or fused is no longer able to bend and twist.
Many herniated discs create symptoms that can often be tolerated. For these patients, conservative care is recommended, in hopes that the inflammation will subside and the herniated portion of the disc will heal. Non-surgical interventions include activity modification, NSAIDS, physical therapy, and possibly steroid injections.
In cases where there are severe symptoms or those that do not respond to conservative care, the recommended surgery is a much less invasive alternative to a fusion, known as a microdiscectomy. In this procedure, a minimal amount of bone and ligament are removed to access the nerve channel and simply extract the displaced portion of the disc compressing the nerve. The incision is typically about 1 inch in length. Patients will often be discharged on the same day of surgery and can return to normal activities within weeks.
A second opinion is highly recommended if you’ve been referred for spinal fusion surgery as the initial surgical alternative to treat a herniated disc. In cases where spinal stability is of concern, it should be demonstrated with appropriate imaging, often more than just an MRI.
When your health and well-being are on the line, it can pay to get a second opinion to ensure you are making the right decisions for your care. A seasoned, compassionate spine surgeon can help guide you in this process.