Your Spine
To best understand your surgery, it is important to know about your spine. The
spinal column surrounds and protects your spinal cord. Your spinal column is
made up of 24 vertebrae (bones), plus the sacrum and the tailbone (coccyx).
Each vertebra is separated by shock-absorbing discs. These discs give your spine
flexibility to move and bend. Nerves branch out from your spinal cord and pass
through openings in these vertebrae to other parts of your body.
What is Lumbar Fusion Surgery?
The goal of lumbar fusion surgery is to relieve pain, numbness, tingling
and weakness, restore nerve function and stop or prevent abnormal motion in
the spine. This is done by fusing the vertebrae together. The lumbar fusion
can be done in the front or the back of the spine.
If the fusion is performed in the front of your spine, the surgeon will remove
the disc (cushion between vertebrae) and any arthritic areas, and place a bone
graft between the vertebrae where it eventually fuses to the surrounding vertebrae
to stop abnormal motion. If the fusion is performed in the back of your spine,
a bone graft will be placed on the sides of the vertebrae where it will grow
together to the vertebrae to stop abnormal motion.
The bone graft may be one of two types: an autograft (bone taken from your
own body usually your pelvis) or an allograft (bone from a bone bank). Sometimes
metal rods, screws or hooks are also used with the bone graft to further stabilize
the spine. This is referred to as "instrumentation."
When the vertebrae have been surgically stabilized, abnormal motion is stopped
and function is restored to the spinal nerves.
What are the Reasons for Lumbar Fusion Surgery?
Lumbar fusion surgery may be indicated for a variety of lumbar spine problems.
Generally, lumbar spine problems are first treated conservatively. Then, if
low back pain, numbness, tingling or weakness in the legs does not improve,
some individuals may be candidates for lumbar spine fusion surgery.
The most common reason for surgery is leg pain or sciatica. This pain may be
the result of a herniated lumber disc causing pressure on one or more of the
spinal nerves. Leg pain may also be caused by abnormal motion of the vertebrae.
What Conditions are Treated with Lumbar Fusion Surgery?
Spondylolisthesis
In this condition one vertebra has slipped forward over another. If the vertebra
continues to slip back and forth, the spinal nerves may be affected, causing
leg pain, numbness, tingling and/or weakness. A spinal fusion may be recommended
to stop this abnormal motion.
Normal and Developmental Defect
Low back pain caused by spondylolisthesis, in which one vertebra slips forward
on another, may be due to a development defect or fracture.
Degenerative Disc Disease
In degenerative disc disease, the discs or cushion pads between your vertebrae
shrink, which can cause abnormal motion and possibly an unstable area in your
spine. As a result, the vertebrae may compress the spinal nerves, leading to
leg pain.
Arthritis
Severe arthritis of the spine is called spinal stenosis. As the body ages,
wom vertebrae and discs may develop bony spurs, which may cause stenosis, or
narrowing of the openings for the spinal cord and nerves. These spurs irritate
the spinal nerve roots and cause pain, numbness, tingling or weakness down the
legs. Sometimes this condition requires lumbar fusion surgery to stabilize the
spine, and prevent abnormal motion after pressure on the spinal nerves is removed.
What are the Potential Complications of Lumbar Spine Fusion Surgery?
As with any operation, there are risks involved with spine fusion surgery.
Some patients may develop a distended abdomen and may not be able to eat. If
this happens, a special tube may be inserted to relieve the distension.
Another complication is a wound infection. Antibiotics are given before and
after the operation to prevent this from occurring.
Urinary problems after spine surgery may include urinary retention and urinary
tract infection. A catheter will be placed into your bladder at the time of
surgery and will be removed as soon as possible when you are up and around.
Some patients may continue to have pain at the bone graft donor site. If the
fusion does not heal, (a condition known as pseudoarthrosis) the instrumentation,
such as rods, screws, hooks may break, and further surgery may be required.
People who smoke are at a higher risk for pseudoarthrosis complications.
Other complications include phlebitis in your legs and blood clots in your
lung. To protect against these problems, you will wear compression boots on
your calves during and after surgery.
Rare complications include a failure to improve, worsening neurological symptoms,
paralysis and possibly death. Your doctor will discuss these potential risks
with you before asking you to sign a consent form.
How is Revision Lumbar Spine Fusion Surgery Different?
Revision surgery often involves correcting a deformity caused by a previously
failed back surgery, breakage of instrumentation or pseudoarthrosis. The type
of revision depends on the problem. The procedure may include operating on both
the front and back of the spine. The incidence of complications from revision
lumbar spine fusion surgery is higher than in first-time procedures. It is also
more difficult to relieve pain and restore nerve function in revision surgery.
Patients should be aware that the chance of having long-term spinal pain is
increased.
Printed with permission from Thomas Jefferson University Hospital
Authors:
Rothman Institute
Department of Home Healthcare
Department of Nursing
Department of Orthopaedic Surgery
Department of Rehabilitation Medicine
Last Updated: 09/05/2006
