In most lumbar fusion surgery procedures, the spine surgeon makes an incision in the abdomen and approaches the spine from the front. The problematic spinal disc— usually the cause of low back pain —is removed. Because the spinal disc provides height and support for the spine, the space that is left once the disc is removed is filled with either bone or a bone-like substance. A bit of synthetic or allograft bone may be used. Once the bone or a bone-like substance is placed, the two spinal bones are joined with screws, plates, and rods. This instrumentation holds the bones in place while the fusion actually fuses or knits together.
Lumbar fusion surgery may be recommended to treat a variety of conditions. Indeed, spinal fusion may be used to treat any number of lower spine problems that cause pain, weakness, numbness, or spinal instability. Unless the patient requires immediate surgery — e.g., fractured vertebra, cauda equina syndrome, etc. — conservative, non-surgical treatments are tried first. If conservative treatments fail to provide symptom relief, spine surgery is indicated.
Back problems treated by lumbar fusion include:
Herniated lumbar disc
Degenerative disc disease
Fractured vertebra (spinal bone)
Tumor (bone cancer or cancer that has metastasized to bone)
Interestingly, spinal fusion was popularized in the early 1900s as a treatment for bone lesions that occur during tuberculosis. In modern times, degenerative disc disease is one of the leading indications for lumbar fusion surgery.
Lumbar fusion surgery usually takes between three and five hours. The procedure is performed while the patient is under general anesthesia. It takes time to properly place the instrumentation (screws, rods). Patients are moved to a post-anesthesia care unit and will likely stay in the surgical center for about 12 to 18 hours.
While the incisions/scars you will see after lumbar fusion surgery are relatively small, the spine surgery procedure is actually quite involved, and recovery can take some time. Remember that the bone needs to heal for the fusion to actually “fuse” if you have ever broken a bone, you know that the bone knitting process takes time. The same thing occurs after spinal fusion surgery.
Recovery Time Patients must avoid certain physical activities for the first week or two after surgery. Things like driving, lifting, twisting, bending, or any form of physical exertion during early lumbar fusion surgery recovery can injure the fusion and interfere with healing. Walking, however, is good and important to do after surgery. The spine surgeon or physical therapist will teach the patient how to walk and move safely during early recovery.
If everything is proceeding well after the first several weeks of lumbar fusion surgery recovery, the patient may be able to participate in a course of physical therapy. A physical therapy program can help patients who have had recent lumbar fusion surgery to regain strength, stamina, and a certain degree of flexibility. The physical therapist and spine surgeon will carefully follow the patient’s progress and (slowly) increase the intensity of physical activity as healing progresses.
Usually around three months after lumbar fusion surgery, the spine surgeon will order an X-ray and CT scan of the lower back to see if the spinal fusion is healing properly. This about the time that physical therapy becomes central to overall recovery and several daily activities can be restarted.
Of note, patients may not be able to return to full activity for six months after lumbar fusion surgery and perhaps as long as one year.
Expectations: pain and rehabilitation
The pain will usually be treated with opioids for a short time and then acetaminophen or ibuprofen/naproxen afterward.
As with any surgery, lumbar fusion surgery is associated with certain risks. Some of the risks associated with lumbar fusion surgery are:
Continuing Or Recurring Symptoms
Lumbar spinal fusion is not always successful in relieving pain or symptoms. A small portion of patients may not achieve the pain relief they were expecting.
Infection is a risk with any invasive procedure, but antibiotics usually prevent or treat infection. Infection within the fusion can be more serious, however.
Patients usually lose very little blood during lumbar fusion surgery; however, blood loss is a possible risk.
Pseudoarthrosis is the medical term for a lumbar fusion procedure that did not fuse into solid bone. Pseudoarthrosis is uncommon but is more likely to occur in patients who smoke, have poorly controlled diabetes, or place too much strain on the lower back too early in the recovery process.
Nerve Or Blood Vessel Damage
While very rare, lumbar spinal fusion surgery is performed near the spinal cord, nerves, and spinal blood vessels. Therefore, nerve damage is a possible risk of lumbar fusion surgery.
In rare cases, the screws used to hold the rods and plates may move out of position or break.
Benefits: How Well It Works.
Lumbar fusion surgery is successful in a majority of patients. The new bone successfully fuses in 85% to 95% of patients. Complication rates of lumbar fusion surgery range from 7% to 23%, though this includes serious and non-serious or temporary/treatable complications. Clinical success – that is, a substantial reduction in symptoms – varies from 60% to 95% with modern approaches.
Why You Should Consider Getting A Lumbar Fusion Surgery
When certain forms of low back pain do not resolve with oral pain medicines, physical therapy, injections, or other conservative treatments, spine surgery is reasonable option. While most patients who need lumbar spine surgery should first consider lumbar artificial disc replacement, some patients will not be candidates. Thus, people who have persistent low back pain and do not qualify for artificial disc replacement should consider lumbar spinal fusion.
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