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Spinal Fusion without Instrumentation and Implants

At A Glance

  • The goal of spinal fusion surgery is to ease the pain of spinal degeneration (spondylosis or degenerative disc disease, facet arthritis, and spondylolisthesis) by stopping motion in the spine through the joining two or more vertebrae.
  • If left untreated, most degenerative spinal conditions will lead to spontaneous fusion – or a natural joining of two or more vertebrae – a spinal fusion surgery can speed up that process by preventing degenerative bone and joints in the spine from grinding together.
  • Spinal fusion is a major operation, and patients wear either a body cast or brace for three to six months until the bones fully grow together.
  • Spinal fusion without instrumentation treats painful Degenerative Disc Disease, patients with Severe Osteoporosis, Facet Arthritis, and certain types of Spondylolisthesis.


Spinal fusion is one of the gold standards in spinal surgery and has been performed for nearly 100 years. In the fusion process, a surgeon uses a bone grafting material to cause two or more vertebrae to grow together into one long bone.

Until the 1960s, spinal fusions were without instrumentation, meaning grafts were performed without screws and other special devices to facilitate the fusion. The success rate were modest at best. Through the years since, orthopedic surgeons have learned much about joining bones with plates and screws and adapted this knowledge to spinal surgery.

Although fusion without instrumentation are still performed, in the best of conditions these kinds of fusions offer a 60- to 70-percent success rate, compared to 90 percent or more with instrumentation.

A surgeon performs traditional spinal fusion surgery by exposing the bone of the vertebra, making it bleed, then placing pieces of bone graft on the bleeding surfaces. The bone graft may come from either the surgery site or more typically from the hip area of the patient (known as an autograph). Human donor bone (allograft) and some synthetic products can also be used. More recently, adult stem cells mixed with platelet rich plasma and bone has been used with increased success.

A fusion operation tries to speed up what Mother Nature is going to do naturally as the spinal degenerative process moves into the end stage of spontaneous fusion. But spinal fusions are performed for other reasons such as fractures, removing tumors, and correction of such deformities as scoliosis.

Spinal fusion surgeries usually require a general anesthesia, blood transfusions, and long operative times. All of the spine muscles around the fusion site need to be cut and often a significant amount of bone is removed.

One of the problems that can occur is that the fusion does not take or heal. This is called a failed fusion, or pseudoarthrosis. This may require that the surgery be done again.

Another potential problem is a condition called “fusion disease” or “post-fusion disease”, a result of tissue disruption and damage during surgery. Fusion disease causes severe localized pain, muscle spasms, nerve irritation, excessive scar tissue formation, and pain at the bone graft site.

Factors that can cause fusion surgery to fail include:

  • Persistent motion at the fusion site
  • Poor health and nutrition
  • Smoking
  • Existing medical conditions such as cardiovascular disease, diabetes, thyroid disorders, obesity, osteoporosis, and certain autoimmune disorders such as Rheumatoid Arthritis
  • Parkinson’s and other neurological movement disorders
  • Non-compliant patient


Frequently Asked Questions

What factors will affect the possible success of my fusion surgery?
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