SPINE - Fusion, Microdecompression, Other Procedures - What to Expect

It has been suggested my experience with both a lumbar and cervical fusion might be of help to those facing the procedure. So here goes:

When I learned this was my option, my first question is what the recovery would be like. I was told: "Worse than a hip, but not as bad as a knee." Being a graduate of both those procedures, that was the information I needed and they were spot on. And depending on the procedure they use, you do end up with more scars than a hip or a knee! I scored 3 for the lumbar and 2 for the cervical. I found the procedures and technology all quite fascinating. And I was fortunate to have one of the top-rated spinal surgeons in the country.

For the lumbar fusion, my OS felt I was a candidate for an anterior approach - a very interesting process. The traditional approach is from the back, where two small graft cages are inserted between the discs to be fused on either side of the central column, and then the supporting rods and screws are inserted. My OS likes the anterior approach because they can insert one larger graft cage from the front, rather than two smaller cages from the back due to the mechanics. What was interesting is what they do with everything in the abdomen so they can get to the discs!

It required a gastro surgeon to move all one's abdominal "innards" to the side, including the main arteries along the spinal column, so the spinal surgeon can clean out any debris and insert the graft cage. Then the gastro puts everything back in place (I hope!) and leaves. After closing the front, they flip you over and insert the rods and screws from the back, with two incisions. The front incision is only about 4 inches vertical; the back about 1" and 2". Are you a candidate for the anterior approach? My OS's partner, whom I saw first, did not think I was. Let's say I am a quite a bit heavier than I would like. But he called in Dr. Melamed who massaged my belly a bit and felt I was. I am not clear on whether the possible issue was weight or mobility of the organs. Who knows, perhaps not having a 6-pack of abs was better.

Likewise with the cervical fusion - insert graft cage from the front, then stabilizing rods and screws from the back, but only one incision there was needed. The worst pain from that one was really the sore throat as your esophagus and trachea have to be moved to the side for access to the spinal column as well. Short horizontal scar on the neck (which works nicely into a fold as you age!).

What is in the graft cage, you ask? It depends on your doctor. Some take a bit of bone from the top of your pelvis crest and mix it with cadaver material. For mine, my OS used cadaver material mixed with some of my bone marrow. They want some of your own material to reduce any likelihood of rejection. I know several people where they used bone from their pelvis and all reported some residual donor site pain years later. I had none of that.

Recovery - take it easy! You won't even be scheduled for PT for 3 months to allow the graft to form and solidify, lest it might dislodge the graft(s) while fusing. If you have a nickel allergy, let your OS know. I have been extremely pleased with the results of both of my fusions. 5 months after the lumbar and 9 months after the cervical, I walked the last 100 km. of the Camino de Santiago in Spain. A new lease on life!