Lumbar spinal fusion: purpose, approaches, risks and recovery

Spinal fusion is chosen when abnormal movement between vertebrae, or a deformity, is thought to cause disabling back and leg pain. RNOH says it is indicated for incapacitating pain from deformity or instability and kept as a last resort. Royal Devon says fusing the vertebrae removes the motion and aims to ease pain.

Most back pain does not need an operation. The NHS says surgery for back pain may be an option if a condition such as a slipped disc is responsible and other treatments have not helped, listing group exercise, physiotherapy, manual therapy and cognitive behavioural therapy among the non-surgical routes.

Because results are less predictable than for operations that free a trapped nerve, it is reasonable to ask for a second opinion and to check that a supervised rehabilitation programme has been tried. Pain management teams may be involved.

• A structured programme of exercise and graded activity, led by a physiotherapist.

• Psychological support for pain, which the NHS lists as part of long-term back pain care.

• Injection or nerve-treatment options discussed by a spinal or pain team.

• Decompression alone, if nerve compression rather than instability is the main problem.

RNOH says to stop smoking or vaping for at least 6 months before surgery, because smoking can stop the bone from fusing. That is a long lead time, so ask your team early whether they will test for nicotine and what support they can offer.

The team will check your general health at pre-assessment and explain fasting for the general anaesthetic. Tell them about all medicines and supplements. Practical planning matters: rearrange your home so that you avoid bending and twisting, put frequently used items at waist height, and organise help for the first weeks.

RNOH says the operation is usually done under general anaesthetic, through the abdomen (anterior), the back (posterior) or the side (lateral). Screws and rods are inserted into the vertebrae, with optional metal cages replacing disc material, plus synthetic or your own bone graft to encourage the bones to join.

Royal Devon says that, after the operation, the physiotherapist sees you on day 1, you are expected to get out of bed and walk that day unless there is a medical reason not to, and you practise stairs before leaving. It is not expected that you will need external bracing, though the surgeon may request one.

RNOH lists nerve injury causing numbness, weakness, paralysis or bladder and bowel problems, deep vein thrombosis, infection of the wound or metalwork, failure of the bones to fuse, and failure to improve current symptoms. Royal Devon says early movement will not damage the stable spine, but forcing movement is not advised.

RNOH quotes improvement figures of more than 50% for back pain and 50 to 80% for leg pain, which means a sizeable proportion do not improve as hoped. Ask your surgeon for their own figures on fusion, infection and revision.

Royal Devon says one to two nights in hospital is normal, no specific spinal exercises are advised in the first 6 weeks, no heavy lifting (maximum around 5kg) for at least 6 weeks, driving once you feel comfortable making an emergency stop (often not until 4 weeks), and swimming or a stationary bike from 2 months.

RNOH says to avoid bending your hips more than 90 degrees, twisting, and lifting more than 1kg in each hand, and says you may start driving after speaking to your consultant at your post-operative clinic review. It notes extensive surgery may need up to six months off work. Differences between hospitals are common; follow your own instructions.

Hull advises contacting the doctor or ward about new numbness or weakness in the arms or legs, changes in bladder or bowel function, and fluid or bleeding outside the dressing. A hot, swollen calf or chest pain or breathlessness needs urgent help; call 999. Numbness around the genitals or bottom, or inability to pass urine, needs A&E.

• What specifically is unstable or deformed in my spine, and how do you know?

• Which approach will you use and what are its risks?

• How many fusions do you perform each year, and what are your outcomes?

• Will I need a brace, and when can I drive and return to work?

• What happens if the bones do not fuse?

The metalwork and technique are broadly similar. NHS spinal services often work as multidisciplinary teams that review whether fusion is appropriate; private care may be faster but the same clinical questions apply. Ask what is included if revision is needed, how follow-up scans are handled, and who supports your rehabilitation after the first 6 weeks.