Sometimes when surgery is recommended a fusion must be considered. Whether it be in the cervical spine or
in the lumbar spine, any fusion operation alters the normal anatomy of the spine and thus has long-term
consequences on the degeneration of the spine. These long term risks must be considered before embarking
on a cervical or lumbar fusion operation.
In the cervical spine, the fusion of two vertebrae is accomplished by removing the disc in between them.
This, however, increases the degenerative stresses on the discs that are next to the fusion site because
the intervening disc is no longer present to absorb its share of the weigh/load. This increases the rate of
degeneration at these adjacent discs and this may increase the long-term need for operations at these discs.
This phenomenon is known as adjacent segment degeneration and occurs at a rate of about 25% over the 10-year
course after a cervical fusion operation. This appears to be related to the lack of motion and stress absorbed
at the site of the fusion. Rapidly emerging new technologies, such as cervical disc replacement surgery, may
alleviate adjacent segment stress and thus lessen the need for adjacent segment surgery in the cervical spine.
NOTE: careful patient selection must be performed because a number of factors determine whether or not someone
is an ideal candidate for a cervical disc replacement surgery.
In the lumbar spine, the fusion of two adjacent vertebrae increases the stress on the adjacent discs and the
remaining non-fused spinal levels. This stress is greater in the lumbar spine than in the cervical spine
because the weight carried by the lumbar spine is significantly greater than the case then the weight carried
by the cervical spine. However, most often - if the lumbar fusion is being performed for the proper reasons -
it may be the only reasonable option of the patient has available to him/her. I do not recommend lumbar fusion
surgery for back pain unless there is spinal instability present. The other reasons to consider lumbar fusion
surgery is for slippage of the vertebra (lumbar spondylolisthesis) or there is a significant risk of creating
instability by removing significant portions of the lumbar vertebrae in the process of decompressing the lumbar
spinal nerves. The risk of subsequent surgery if the original fusion surgery does not heal and the risk of
surgery for adjacent segment degeneration must be discussed and understood prior to undergoing a lumbar fusion
operation. Unfortunately, lumbar disc replacement technology has not advanced to the level of common use, as
it has in the cervical spine.
Please discuss your specific situation with a board certified, fellowship-trained orthopedic spine surgeon.
Mir H. Ali, MD,PhD
Director - Deerpath Spine Institute
Orthopedic Spine Surgeon - Rezin Orthopedics & Sports Medicine
Dr. Ali is a board certified orthopedic spine surgeon trained in the diagnosis as well as the treatment of
non-operative and operative spinal disorders. Dr. Ali practices in the far western and southwestern
suburbs of Chicago and utilizes surgery as a last resort when all other non-operative treatments have
failed to relieve pain and/or reduce risk of nerve damage/injury. All recommendations on this site are for
general situations and a particular situation requires evaluation before specific treatment recommendations
can be made.