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Understanding Lumbar Fusion Surgery

Lumbar Fusion Surgery Overview Chapter 1

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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

lumbar fusion surgery normal pars defect spondylolisthesis todd albert

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.

lumbar fusion surgery arthritis spine todd albert

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

Updated on: 09/07/12
John J. Carbone, MD
In the overview of Lumbar Spine Fusion Surgery by Dr. Todd Albert, Dr. Albert reviews some of the basic principles in spinal decompressive fusion surgery. A current key concept to understand is the addition of spinal instrumentation to lumbar fusion surgery.

Early experience with un-instrumented spinal fusion surgery often led to long periods of bed rest, as well as long periods of recuperation coupled to relatively low fusion rates when compared to most newer standards in spinal surgery. Recent articles studying large series of lumbar spinal fusion and decompressive surgeries for degenerative spondylolisthesis and stenosis showed patient satisfaction rates to be in the same range at approximately 93% as some in the total joint literature. Joint replacements are largely regarded as one of the most successful operative procedures performed on human beings.

Another concept to emphasize would be the advent of our increasing life span and long clinical history of spinal surgery has lead to a higher rate of revision spinal surgery in the aging population. While revision surgery can be technically challenging it also presents a patient a second chance at getting well as their spinal pathology continues to progress. Outcomes, of course, are based on the presenting diagnosis, clinical pathology, age, and health of the patient, as well as the experience and technology applied by the surgical team.

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