Introduction
The lumbar spine is lowest section of the back (or ‘the lower back’), usually comprising of five verterbrae, designated L1-L5 (L1 is the topmost and L5 at the bottom). A lumbar spinal fusion procedure is a procedure to 'fuse' or join two vertebrae together to prevent that specific joint from moving independently.
The lumbar fusion can be approached in different ways - either from the front (‘anterior lumbar interbody fusion’ or ALIF), or from the back (‘posterior lumbar interbody fusion’ or 'PLIF'), or from the side (‘transforaminal lumbar interbody fusion’ or ‘TLIF') or extreme lateral interbody fusion (X-LIF).
A lumbar spinal fusion is often conducted together with a lumbar laminectomy to ensure sufficient stability in the spine after decompression of the spinal nerves.
Indications
A lumbar spinal fusion may be required to treat the following conditions…
- Injury / trauma (e.g. fractured vertebra).
- Spondylolisthesis (misalignment of vertebrae).
- Scoliosis/kyphosis (abnormal curvature of the spine).
- Disc prolapse.
- Infection/tumour (causing an unstable spine).
Preoperative Instructions
Before all neurosurgical procedures, including the lumbar spinal fusion, you should…
- Stop all oral intake (i.e. no food or drink) from midnight the night before the procedure. You can continue taking medications with very small sips of water.
- If possible, stop taking any non-steroidal anti-inflammatory medication (NSAIDs) two weeks ahead of the procedure due to effects on thinning the blood and prevention of bone healing.
- If you take blood thinners, please inform your doctor so you can be advised about stopping them before the procedure.
- Avoid dental treatment (within three weeks) or any other form of surgery (within three months) of the planned procedure.
- If you develop any symptoms of infection, e.g. a cold or flu, before surgery, or if you are receiving treatment for an infection, please let our office know as your procedure may be postponed.
Procedure
The procedure involves the placement of metal implants (such as screws and rods) into vertebra with cages containing bone material (this can be from the patient's own body or synthetic bone) wedged in the disc space between the two target vertebrae to encourage them to fuse together. The cages may be made of plastic or titanium.
In some cases, extra bone may need to be positioned at the sides of the spine – this is called a posterolateral bone graft.
The procedure can be undertaken using either conventional (i.e. 'open') surgery or using minimally invasive ('keyhole') techniques. The main benefit of the minimally invasive approach – if this is an option – is multiple smaller incisions and possibly faster recovery times.
All procedure types are performed under general anaesthesia, with the patient either lying normally or face down on the operating table, depending on the approach.
Postoperative Instructions
After the procedure is completed, patients generally need to stay in hospital for 4-7 nights. After returning home, normal light day-to-day activity is all that should be undertaken for around two weeks. At the end of this period, you should be able to start driving again and return to (sedentary type) work at the 4-6 week mark. For more strenuous work, it is advisable to wait until the 6-8 week mark.
Risks
The following complications are not common, but can occur after a lumbar spine fusion procedure…
- General risks associated with surgery / anaesthesia.
- Bone graft issues, such as infection, rejection, fusion not occurring.
- Failure of metal components.
- Nerve injury.
- Spinal fluid leakage.
- Spinal cord injury.
Treatment Alternatives
Treatment alternatives to lumbar spinal fusion surgery include pain medication, physical therapy and injections. Simpler operations such as lumbar laminectomy may also be an alternative.