Posterior spinal fusion is a surgical technique aimed at the stabilization and fusion of two or more vertebrae. It can be performed at the cervical, thoracic, lumbar or sacral level, depending on the condition being treated.
The goal of the procedure is to eliminate abnormal or painful movement between the affected vertebral segments, restore spinal stability and, when necessary, correct deformities or protect the nerve structures following surgical decompression.
Indications
This procedure is used in all conditions requiring stabilization of a segment of the spine. The most frequent indications include spinal canal stenosis, especially when decompression may cause instability, degenerative disc disease associated with persistent low back pain, spondylolisthesis, traumatic or pathological vertebral fractures, spinal deformities such as scoliosis or kyphosis, and certain tumor-related or infectious conditions that compromise spinal stability.
Fusion can therefore serve different purposes: stabilizing an unstable segment, correcting a misalignment of the spine, reducing mechanical pain or completing a decompression procedure of the nerve structures.
Surgical technique
The procedure is generally performed with the patient in the prone position, lying face down, under general anesthesia.
Stabilization is usually achieved by inserting screws into the pedicles or vertebral bodies. The screws are then connected to each other using metal rods, which are secured with dedicated nuts or locking systems. This creates a rigid structure capable of immobilizing the affected vertebrae and holding them in the desired position.
In many cases, in addition to mechanical stabilization, the process of bone fusion between the vertebrae is also promoted. This can be achieved using autologous bone graft, allograft bone or osteoconductive substitute materials, placed in the appropriate locations to facilitate the formation of a stable bony bridge over time.
Open Fusion
Posterior fusion can be performed using the traditional open technique. In this case, a wider skin incision is made, allowing the surgeon to directly expose the vertebral structures.
This approach is particularly useful when, in addition to stabilization, it is necessary to perform decompression of the spinal canal or nerve roots, as in cases of lumbar stenosis, herniations associated with instability, spondylolisthesis or complex deformities.
The open technique allows direct visualization of the surgical field and enables more extensive maneuvers, such as laminectomies, foraminotomies, alignment correction or careful preparation of the bone surfaces to promote fusion.
Percutaneous or Minimally Invasive Fusion
In certain selected cases, the procedure can be performed using a percutaneous or minimally invasive technique. In this approach, the screws are inserted through small skin incisions, with the aid of intraoperative radiological guidance or navigation systems.
The main advantage of this technique is the reduction of surgical trauma to the paravertebral muscles and tendon structures. This can result in less post-operative pain, reduced blood loss, earlier mobilization and potentially faster recovery times.
The percutaneous technique is particularly indicated in cases where the main goal is stabilization, such as in certain vertebral fractures or specific degenerative conditions, whereas it may not be sufficient when extensive decompression or complex deformity correction is required.
The choice between open and minimally invasive technique depends on the type of condition, the number of levels to be treated, the patient’s anatomical characteristics and the surgeon’s experience.
Duration of the procedure
Post-operative course
The post-operative course also varies considerably depending on the complexity of the procedure. After limited, minimally invasive procedures, mobilization can occur early, often within the first few days, according to the guidance of the surgeon and physical therapy staff.
After more extensive procedures, on the other hand, a longer period of monitoring, pain control, functional recovery and rehabilitation may be needed. In some cases, the use of an orthopedic brace may be prescribed to protect the operated segment during the early stages of healing.
Hospital stay can therefore range from a few days in the simplest cases to longer periods for patients undergoing complex procedures or with particular clinical conditions.
Convalescence and return to activities
Recovery after posterior fusion depends on the type of procedure performed, the number of levels stabilized, the patient’s age, general condition and the presence of any pre-existing neurological deficits.
In less complex cases, a gradual return to normal daily activities can occur within about one month. In more demanding cases, especially after extensive fusions or deformity corrections, convalescence may take 3-4 months or more.
During the recovery period, it is essential to avoid excessive exertion, sudden twisting of the trunk, lifting weights and unauthorized physical activity. Return to work and sports must be assessed individually, based on the type of activity performed and the clinical and radiographic progress.
Treatment goal
The main goal of posterior fusion is to achieve solid, lasting stabilization of the affected spinal segment. This helps reduce pain related to instability, protect the nerve structures, correct any deformities and improve the patient’s quality of life.
The success of the procedure depends on a correct surgical indication, an appropriate operative technique and adherence to post-operative instructions during the healing period.
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