The general public’s understanding of spinal fusion often starts with a misconception.

When Dr. Hunter Dyer talks to people about lumbar fusion, many think that it’s the screws doctors place that are the fusion. But that’s not true — the hardware just holds the spine in alignment until the vertebrae or spinal elements grow back together.

As an expert in spinal fusions, Dr. Dyer is familiar with what people get wrong or just don’t understand about caring for their spine and fixing spinal issues. It’s a complicated field of medicine and, as such, patients considering surgery like a fusion should consult with an expert first.

For example, Dr. Dyer says that most patients with back pain don’t actually need surgery. Rather, alternative care like physical therapy is often a better starting point before committing to the sometimes-extensive recovery from a fusion procedure.

In addition, there are myriad risk factors to consider: Does the patient smoke? What’s their surgical history? How old are they? What’s their body type? All these things and more, Dr. Dyer says, can influence whether a patient is a good candidate for a spinal fusion.

On this episode of Back Talk Doc, Dr. Dyer explains all things spinal fusion with host Dr. Sanjiv Lakhia.

💡 Featured Doc 💡

Name: Dr. Hunter Dyer

What he does: Dr. Dyer is an expert in degenerative spine disease, endoscopic spine surgery, minimally invasive spine surgery, skull base surgery, spinal fusion, transsphenoidal surgery and vascular neurosurgery. He is the President at Carolina Neurosurgery & Spine Associates. 

Company: Carolina Neurosurgery & Spine Associates 

Words of wisdom: “The key to any great job, or being good at what you do, is I absolutely love what I do. I wake up every single day excited to see what I've got for the day and see if I can help people surgically, to see if I can help people in the clinic. And that's why we love being physicians and we love being in health care, because it's just so rewarding.” 

Connect: LinkedIn

⚓ Anchor Points ⚓

Top takeaways from this Back Talk Doc episode 

★    Most spinal issues probably don’t need surgery. Even as a surgeon, most patients Dr. Dyer sees can address their issues with conservative care — physical therapy, spinal traction, or injections. “The only people that we need to consider for spinal fusion are typically those that have problems where they require so much bone removal that they require stabilization of the spine,” he says.

★    Smoking is a major risk factor for spinal issues. It can affect people with problems in either the neck or back. “We typically do not like to even consider spinal fusion if somebody is using tobacco,” Dr. Dyer says. “If they've used it in the past, it's likely that they get degeneration of the disk and that can lead to accelerated adjacent-level problems.” 

★    The direction of spinal surgery can influence the healing process. Dr. Dyer explains that when a surgeon uses a lateral approach, patients don’t often experience a lot of pain. When the best course of action involves the posterior or anterior approach, patients can experience more pain after surgery. “In general, there's more pain with the posterior approach, but it's still the most common way because it does provide that direct view of the nerves,” he notes. 

★    Spinal fusion techniques are advancing rapidly — which is good for patients. In the past five years, technology has advanced so that surgeons can be more precise with placing screws, thanks to MRI and CT images. In addition, robotic tools have made surgery much safer and much easier to heal from. “For many people, it’s just a better thing all around,” Dr. Dyer says.

⚕️ Episode Insights⚕️

[00:00] Mobile-based solutions for clinical practice: Check out our sponsor, QxMD, mobile solutions for driving evidence-based medicine in clinical practice.

[01:45] Introducing the physician: Dr. E. Hunter Dyer is a specialist in degenerative spine disease and endoscopic spine surgery, among other things.

[03:50] Neurosurgery isn’t just for the brain: The reality, Dr. Dyer says, is that spinal issues make up the majority of neurosurgeons’ caseloads.

[05:50] Conservative care can help most spinal issues: Care options like physical therapy or injections are often the first steps in recovery before exploring spinal fusion.

[8:20] What is lumbar fusion?: It’s not actually referring to the hardware. “Fusion is actually the growth between or around the spinal elements, whether it's the vertebrae growing together, or whether it's the spinal elements in the back part of the spine that grow together,” Dr. Dyer explains.

[10:40] Two types of spinal instability: One is in patients who haven’t had any procedures and have their vertebrae moving due to degeneration of spinal joints; the other is found in someone who has had excess bone removed, creating an unstable spine where doctors must secure spinal segments.

[13:00] Changes for lower back care: Dr. Dyer says spinal fusions for lower back pain are much less common than they were a decade ago. 

[15:30] Differences in lumbar fusion acronyms: Dr. Dyer explains what ALIF, XLIF and other types of fusions actually mean.

[18:40] Recovery times vary: Dr. Dyer explains how and why the healing will differ depending on whether a surgeon uses an anterior, lateral, or posterior approach.

[20:40] Complexities of evaluating spinal surgery: A myriad factors within a patient can influence what types of treatment are best.

[23:44] Breaking down recovery restrictions: Post-surgery recovery varies from person to person but often can last several weeks at minimum.

[27:15] Benefits of physical therapy: Most spinal fusion patients find that physical therapy helps at a certain point in their recovery.

[28:26] On adjacent-level disk disease: Dr. Dyer explains the importance of identifying the exact problem in the patient, common post-spinal fusion issues and risk factors.

[32:27] Outlook for future surgery: There is a possibility that patients who have lumbar fusion could require an extension or further surgery down the road. Dr. Dyer says while it’s not common and it is a “complete game changer” for some, doctors should educate patients about possibilities down the road.

[34:45] Are spinal fusion surgeries overdone?: Dr. Dyer discusses why some in the medical community have the perception that not all spinal fusions are necessary and shares current insights on when it makes sense to skip the procedure.

[37:06] Looking ahead: Robotic tools, minimally invasive procedures, and new imaging technology are making for quicker-healing and less-painful procedures. “There also are incredible advances in what we call navigation,” he says, noting that navigation enables doctors to attach instruments to the imaging study.

[40:43] Final thoughts: “I'm not the best example of somebody who is an extremely regular exercise person, but I stay on the go and I think my metabolism stays at a high rate, which helps,” he says reflecting on what has helped his success. “I lean on having great family support. I've got a great wife and kids. And also the key to any great job [is] I absolutely love what I do.”

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👉 If you enjoyed this episode of Back Talk Doc, check out our recent episode Reduce Back Pain and Improve Posture with Active Sitting.

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Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1