Conditions Treated

Spinal Fusion

Spinal fusion is a surgical procedure used to unite adjacent vertebral bones with each other. Normally, the bones are separated by joints and the intervertebral disc allowing them to move past each other. Spinal fusion is essentially a "welding" process. Your body does the “welding” by having bone grow in areas the physician performed the surgery. A bony bridge forms between the vertebrae and holds them rigidly in place. If movement continues to occur at the site of fusion surgery after the anticipated fusion date, this is referred to as a non-union(or pseuarthrosis). Many patients mistakenly think that it is the metal implants placed in the bones that fuse the spine. These implants play the role of a scaffold that holds the adjacent bones fixed in place until the body lays down new bone.

Spinal fusion may relieve symptoms of many back conditions, including:

Spinal fusion eliminates motion between vertebrae. It also prevents the stretching of nerves and surrounding ligaments and muscles. It is an option when motion is the source of pain, such as movement that occurs in a part of the spine that is arthritic or unstable.

If you have leg pain in addition to back pain, your surgeon may also perform a decompression A spinal decompression is a procedure which involves removing bone and diseased tissues that can put pressure on spinal nerves.

Fusion will take away some spinal flexibility, and the amount of flexibility lost is directly proportional to the number of level fused.

Lumbar spinal fusion has been performed for decades. There are a variety of different techniques that may be used to fuse the spine. There are also different surgical approaches that the surgeon can utilize to perform the procedure(Anterior; Posterior;Lateral). Each approach has its own pluses and minuses as well as unique risks. The approach should be tailored to the pathology.

Bone Grafting

All spinal fusions use some type of bone material, called bone graft, to help promote the bone to fuse. Generally, small pieces of bone are placed into the space between the vertebrae to be fused.

A bone graft is primarily used to stimulate bone healing. It increases bone production and helps the vertebrae heal together into a solid bone. Depending on the goals of surgery, larger, solid, pieces of bone graft are used to provide immediate structural support to the vertebrae.

In the past, a bone graft harvested from the patient's hip was the only option for fusing the vertebrae. This type of graft is called an autograft. Harvesting a bone graft requires an additional incision during the operation. It lengthens the duration of surgery and can be associated with a separate area of pain after the operation.

One alternative to harvesting a bone graft is an allograft, which is cadaver bone. An allograft is typically acquired through a bone bank. The bone from the donor is highly processed and tested to ensure that there is minimal risk of disease transmission.

Recently, several other bone graft materials have been developed.

Demineralized bone matrices (DBMs)
DBM is derived from cadaver bone. Calcium is removed from cadaver bone by a chemical process. Without the calcium (mineral), the bone can be changed into a putty or gel-like consistency. DBMs are usually combined with other grafts, and may contain proteins that help in bone healing.

Bone morphogenetic proteins (BMPs)
This is a synthetic bone-forming protein used to promote a solid fusion. They are approved by the U.S. Food and Drug Administration for use in the spine in certain situations. BMPs are used when autograft is not available.
Ceramics. Synthetic calcium/phosphate materials are similar in shape and consistency to autograft bone.


After bone grafting, the vertebrae need to be held together to help the fusion progress.

In many cases, plates, screws, and rods are used to help hold the spine in a fixed position. This is called internal fixation, and may increase the rate of successful healing. With the added stability from internal fixation, most patients are able to move earlier after surgery.


As with any operation, there are potential risks associated with spinal fusions. It is important to discuss all of these risks with your surgeon before your procedure.

Warning Signs

It is important that you carefully follow any instructions from your doctor relating to warning signs of blood clots and infection. These complications are most likely to occur during the first few weeks after surgery.

Warning signs of possible blood clots include the following:

Occasionally, a blood clot will travel through the blood stream and may settle in your lungs. If this happens, you may experience a sudden chest pain and shortness of breath or cough. If you experience any of these symptoms, you should notify your doctor immediately. If you cannot reach your doctor, someone should take you to the hospital emergency room or call 911. Infection following spine surgery occurs very rarely. Warning signs of infection include:

If any of these symptoms occur, you should contact your doctor or go to the nearest emergency room immediately.


The fusion process takes time. It may be up to a year before the bone is solid, although your pain levels will often improve much faster. During this healing time, the fused spine must be kept in proper alignment. You will be taught how to move properly, reposition, sit, stand, and walk.

To schedule and evaluation with Dr. Siemionow, click here.

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