When should you NOT have spinal fusion surgery?

Spinal fusion surgery has helped thousands of individuals have less pain, increase mobility, and enjoy life more fully. Nonetheless, spinal fusion surgery is not for everyone. A number of conditions are absolute contraindications to spinal fusion surgery, which means surgery is simply not safe under those circumstances. Likewise, there are number of relative contraindications that may or may not delay a spinal fusion surgery.


Absolute contraindications to spinal fusion surgery

Spinal fusion surgery should not be performed under three circumstances. Fortunately, these circumstances are rare.

  1. Spinal fusion surgery should not be performed on a patient who has tumors in more than one vertebral body such that the surgeon cannot place instrumentation in healthy tissue. In other words, when cancer has invaded a substantial portion of the spine it is difficult, and perhaps impossible, to place the metal hardware along the spine required to fuse vertebral bones together. Simply stated, the surgeon cannot and should not anchor spinal surgery hardware to vertebral bones laden with tumors.
  1. Severe osteoporosis is an absolute contraindication to spinal fusion surgery. This makes sense since the vertebral bones are too fragile to be used to anchor the hardware necessary to fuse the spine. Unfortunately, severe osteoporosis may take years to correct with medication, if it can be corrected at all. This is why severe osteoporosis is considered an absolute contraindication, rather than a relative contraindication to spinal fusion surgery.
  1. If there is any evidence of infection around the spine, spinal fusion surgery cannot occur. More specifically, infection of the soft tissue around the spine or in the epidural space could risk transferring infectious material into the bone itself during surgery. On the other hand, an active spine infection (discitis/osteomyelitis) does not necessarily stop a fusion and instrumentation. In fact, advanced spine infections may be a reason to emergently perform spinal surgery (to stabilize the infected spine).

Relative contraindications to spinal fusion surgery

One of the most important roles for any surgeon is to determine when a person should or should not have surgery. In the case of relative contraindications, this decision becomes more complex. In some instances, usually through medical treatment, these conditions can be corrected to a point at which surgery is safe. If they cannot be corrected, surgery may not be possible.

The eight relative contraindications to spinal fusion surgery are:

  1. Anemia – Strictly speaking, anemia means too few red blood cells in the blood; however, too few platelets (thrombocytopenia) is also a reason to postpone spinal fusion surgery. Both of these conditions can be corrected through transfusion.
  1. Chronic hypoxemia- Chronic hypoxemia is a condition in which oxygen levels in the blood are low and have been for a long period of time. This is usually a consequence of COPD or chronic lung disease (e.g., sarcoidosis, idiopathic pulmonary fibrosis, etc.). Too little oxygen in the blood may interfere with wound healing or increase the risk of complications during the procedure. Less severe cases of chronic hypoxemia may not prevent spinal fusion surgery, though the anesthesiologist usually must help make this determination.
  1. Malnutrition- Malnourished individuals have a difficult time recovering from surgery. Surgery can proceed if the person can regain his or her strength through proper nutrition.
  1. Osteoporosis- Moderate osteoporosis may delay spinal fusion surgery until it can be corrected medically.
  1. Severe cardiopulmonary disease- The heart and lungs must be healthy enough to undergo general anesthesia. In some cases, heart and lung function can be improved through medical treatment making spinal fusion surgery possible.
  1. Severe mental illness- Severely mentally ill individuals, such as people with severe depression or schizophrenia, are unlikely to be able to adhere to preoperative/postoperative instructions and rehabilitation requirements. With proper support before and after surgery, even the severely mentally ill may be able to undergo spinal fusion surgery.
  1. Smoking- Active smoking is a relative contraindication to virtually every surgical procedure that requires general anesthesia. Smoking greatly increases the risk of complications during surgery and delays healing and recovery after surgery. Patients who can avoid smoking prior to the procedure may be candidates for spinal fusion surgery.
  1. Systemic infection – While an infection around the spine is an absolute contraindication to spinal fusion surgery, and infection in another area of the body may also delay the procedure. It is critical that infectious particles, i.e. bacteria, viruses, etc., do not enter the surgical area. In most cases, a person with a fever or other symptoms of infection will not undergo surgery until the infection has been successfully treated.

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