Lumbar fusion spine surgery is a treatment procedure in which affected or injured lumbar vertebrae are fused together. When the vertebrae have been surgically stabilized, abnormal motion is stopped, function to the spinal nerves is restored, and disc height returns to normal.
Lumbar fusion surgery is performed in an attempt to:
- relieve pain
- relieve numbness/ tingling
- relieve weakness
- restore nerve function
- stop/prevent abnormal motion in the spine
- restore disc height
- stabilize the spine
Types of Fusion Surgeries
The type of spinal fusion surgery you will have is dependent on the patient's symptoms and specific diagnosis. Patients should discuss the exact approach for their lumbar spinal fusion surgery with their surgeon.
The different types of spinal fusion surgery are:
- anterior fusion - performed through the front of the spine
- posterior fusion - performed through the back of the spine
- transforaminal fusion - performed through the foramina (openings) of the spine
- extreme lateral fusion - performed through the side of your spine
Lumbar Fusion with Instrumentation
Depending on the individual patient, a spine surgeon can choose to also have metal rods, screws or plates used in combination with the bone graft to further stabilize the spine.
The type of instrumentation used is dependent on the fusion approach chosen by the surgeon as well as the specific diagnosis causing the pain.
A bone graft may also be required. Bone grafts are used by spine surgeons to replace missing sections of bone. There of the two most common types of bone grafts used in spinal fusion surgery are:
- autograft - small piece of bone taken from the patient's body, usually the pelvis or hip
- allograft - small piece of bone taken from a bone bank
About Lumbar Fusion Surgery
For most spine fusion surgeries, patients are given general anesthesia to put them to sleep. A breathing tube may also be inserted to assist the lungs throughout the procedure.
Patients are placed on a special operating room bed that allows for optimal access to the spine and room for the surgeon to work and helps greatly reduce the potential for blood loss.
Your doctor will make a short incision in your back to expose the correct area of the spine. Depending on the type of fusion being performed, two incisions may need to be made, one on either side of the spine. An X-ray called fluoroscopy is used in the operating room to ensure the correct bone/disc(s) is operated upon. Some spine surgeons may also use a special surgical microscope during surgery to magnify the area they are operating upon, if necessary.
Your spine surgeon may use small cutting instruments to carefully remove soft tissue near the spinal nerves. Before fusion takes place, the surgeon removes all or part of the lamina bone, takes out any disc fragments and eliminates any nearby bone spurs (laminectomy). Next, your surgeon will remove the affected (vertebral) disc, which is the cushion between your vertebrae, as well as any arthritic areas. A bone graft is then placed between the vertebrae where the disc was originally. Eventually, this graft will fuse to the surrounding vertebrae to prevent abnormal motion of the area of the spine.
At this time, your spine may choose to fix the bones in place with a single choice or combination of metal screws, rods and plates. A fusion with instrumentation (hardware) can hold the vertebrae in place while the bone graft fuses properly. The less motion there is between the healing bones, the higher the chance of successful fusion. Instrumentation has increased the success rate of spinal fusions considerably.
Once this is complete, the muscles and soft tissue is put back into place and the skin is closed with sutures, staples, skin glue or steri-strips (small pieces of tape).
Lumbar Fusion Hospital Recovery Time
Your length of lumbar fusion recovery time in the hospital will depend on the reason that you needed to have a lumbar fusion. Most patients go home one to two days after surgery, but your spine surgeon will decide when you are ready for discharge.
If you require some rehabilitation before going home, a physical medicine and rehabilitation doctor will see you and make specific recommendations regarding your discharge. You need to be able to walk, eat, urinate, and your surgical wound must be healing well.
Lumbar Fusion Recovery at Home
- You should continue to gradually increase your activity and walking within and outside the home is encouraged.
- Avoid lifting and strenuous activity
- Do not lift objects greater than 10 lbs. until advised by your doctor
- Avoid lifting above the waist level and above your head for any prolonged period of time
- You are not allowed to drive a car. Your doctor will give you specific instructions about driving on discharge or when you follow-up in the office. You can ride as a passenger in a car as directed and must always wear your seatbelt.
- Climbing stairs at home is permitted and tolerated with caution.
- You may need to wear a back brace – your spine surgeon will instruct you as needed.
- Sexual activity may resume when indicated by your doctor.
- Remember to call and schedule your follow-up appointment with your doctor once you are at home.
- You may shower, but avoid bathtubs, whirlpools and swimming pools until cleared with your doctor.
- If you have steri-strips (strips of tape), cover your incision as directed by your doctor. You or a companion may remove the tapes as directed. If your tapes do get wet, you may pat tapes dry or use hair dryer on cool setting.
- If you have staples, you may shower but do not scrub over incision.
- DO NOT apply lotions or creams near incision site.
Contact your doctor immediately if you have:
- swelling on or around the incision
- incision becomes red and hot or has drainage
- difficulty breathing or chest pain
- swelling or tenderness in your legs or calves
- fever of 100° or higher