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Spinal Fusion

Children's Mercy is an American College of Surgeons Verified Center

There are two types of spinal fusion procedures: Anterior Spinal Fusion and Posterior Spinal Fusion. Here you'll learn about the differences between the two as well as how each procedure works.

Anterior Spinal Fusion

With certain kinds of spinal curves, the correction and fusion is best done anteriorly, or from the front. This process is known as anterior spinal fusion.

How the procedure works

The front of the spine is approached from the side of the patient. An anterior approach may be indicated if the curve that needs correction is in the lower spine (thoracolumbar or lumbar curves). During this procedure, there is a discectomy (removal of the disc) stabilizing the spine with screws and rods, and adding bone graft which provides the eventual fusion. This is a highly successful way of correcting a child’s spine deformity and obtaining good spinal balance with a shorter fused segment.

Ensuring the best outcomes

As with posterior spinal fusion and instrumentation, an anterior procedure is a complex surgery and not without risks. Monitoring of the nerves is performed throughout the procedure by a specially trained staff member. A blood transfusion may also be required during or after surgery. Pain after surgery is controlled by our pain management team. Total hospitalization is usually 3-4 days with a possible overnight stay in the Pediatric Intensive Care Unit.

Posterior Spinal Fusion

Posterior spinal fusion with instrumentation is the most common surgery for idiopathic scoliosis in a young person who is skeletally mature or close to skeletal maturity.

How the procedure works

The spine is operated on through a long incision made straight down the back. Instrumentation, consisting of rods with screws, hooks or wires placed into the vertebrae of the spine, are used to partially straighten the spine and hold the spine in a better position. Bone graft, which consists of chips of bone, is then placed along the spine. Bone graft is typically obtained from the bone bank but occasionally may be obtained from the patient’s own iliac crest. The rods and screws hold the spine in its corrected position until the bone graft becomes solid and the spine can no longer curve. This fusion usually takes twelve months to become completely solid. Typically the instrumentation is left in place after the fusion is complete. Bracing is not usually necessary after surgery.

What to expect after surgery

A posterior spinal fusion is a long complex surgery and not without risks. The surgery typically takes 4 hours for an otherwise healthy young person with idiopathic scoliosis. In a more medically complex children such as with neuromuscular scoliosis, this surgery may take closer to 5-6 hours. Most children will require blood transfusions during and sometimes after the surgery. Most children have neuromonitoring throughout the operation by a staff member specially trained in this technique. Pain after surgery is controlled and monitored by a special pain management team. Total hospitalization time is usually 3-4 days. Intensive care stay is not indicated for this suregery in an otehrwise healthy young person. However, more medically complex children may require immediate postoperative stay in the Pediatric Intensive Care Unit and a longer hospitalization.