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Spinal Fusion Procedure

A spinal fusion is when 2 or more blocks of bone (vertebra) are made into one. Due to improper alignment or incompetency to maintain alignment, the spine begins to injure nerves or places the spinal cord or nerves at risk for injury or damage. Preservation of nerve function is the mantra. In a spinal fusion, the vertebras are fused together by bone graft and instrumentation (eg. screws, rods, and plates).

Spinal fusions are required for various conditions such as fractures, dislocations, infections, scoliosis, spondylolisthesis, and other deforming conditions. Although most patients with neck or back pain can be treated with non-operative means, it has become more common to treat the problems of incompetent discs with spinal fusion.

There are various techniques for performing a spinal fusion. The primary goal of the procedure is for one bone to heal to another. The biologic material used is of utmost importance. An autograft is a bone that is harvested from the patient’s body and transplanted to another area where it is needed. Autograft is considered a gold standard. An allograft is a bone that is taken from the donor or bone bank and is transplanted into the patient. There are techniques of using proteins (bone morphogenic protein-BMP and osteogenic protein-OP-1) in various stages of development and FDA approval for use to augment fusions. Intervertebral spacers, whether a bone or polyetheretherketone (PEEK), are used to maintain the spatial relationships of the vertebrae. Metallic instrumentation (screws, plates, and rods) made of surgical titanium may be required to maintain the proper spinal alignment while the body is healing.

When a portion of the body is painful (arm, leg, or spine), the person will splint that body part, thus limiting motion. When vertebrae are fused, it creates a limiting motion in that specific part of the body. In the lumbar spine, when a one level fusion is performed, this results in only 7° loss of motion. Thus the actual fusion only accounts for a small loss of motion.

Once a fusion is performed there is concern that a disc bordering a fusion will begin to deteriorate. This is indeed true. The incidence is somewhere between 15 -52%. The good news is that most are asymptomatic. The bad news is that as the patient ages their discs will continue to deteriorate and may become more symptomatic with time. One has to weigh this (an unknown possible situation) versus the improvement in quality-of-life provided by the surgery.

To learn more about Dr. Cotler or to schedule an appointment, please call us on (713) 523-8884 or visit


Howard B. Cotler, MD, FACS, FAAOS is board certified and recertified in Orthopedic Surgery. He is a fellow of the American Academy of Orthopedic Surgery and the American College of Surgeons.

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