Lumbar Fusion Spine Surgery

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 is restored.

Lumbar fusion surgery is performed in an attempt to:

Types of Fusion Surgeries

The type of spinal fusion surgery you will have is dependent on your 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
  
• oblique fusion - an approach to the front of your spine from the side of your body
  
• extreme/direct lateral fusion - performed through the side of your spine
  

Lumbar Fusion with Instrumentation

Depending on the individual patient, a spine surgeon will choose between 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.

Bone Grafts

A bone graft may also be required. Bone grafts are used by spine surgeons to aid the body in its healing process and ensure a solid fusion. 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 or from the area of the spine that is already being operated on
  
• 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. 
Patients are placed on a special operating room bed that allows for optimal access to the spine, room for the surgeon to work and helps greatly reduce the potential for blood loss.

Your doctor will make a precise incision in your back to expose the correct area of the spine. If minimally invasive spine fusion is 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. Depending on the needs of your surgery your surgeon may use various specialized robotic and/or navigation devices to assist with your surgery.

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, 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 cage with bone graft is then placed between the vertebrae where the disc was removed. Eventually, this graft will fuse to the surrounding vertebrae to prevent abnormal motion of the area of the spine. 

Depending on the approach for your procedure, you may then require a plate with or without rods and screws to stabilize your spine. 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 are allowed to return to their natural position and are secured with sutures. The skin is closed with sutures, staples, skin glue or small surgical bandage strips.

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. Walking in and outside of 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.
    
• 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, usually two weeks after surgery.
  
• Remember to call and schedule your two-week follow-up appointment with your doctor once you are at home.
  

Wound Care

• You may shower, but avoid submerging in bathtubs, whirlpools or swimming pools until cleared with your doctor.
  
• If you have surgical bandage strips over your incision these will usually fall of on their own. You should remove the strips if they have not fallen off after one week.
  
• You may shower after surgery while keeping the incision completely dry. After 72 hours, it is generally safe to gently wash the incision in the shower without vigorous scrubbing.
  
• 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 101° or higher