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Spinal Fusion Surgery at Our Los Angeles Center

Lumbar fusion is a commonly performed lumbar spine surgery that immobilizes vertebral bones in the lower spine. Protecting a segment of the spine from excessive or misaligned motion may help relieve pressure on the nerves in that area, reducing chronic inflammation and irritation. Fusion may be combined with other types of lumbar spine surgery such as a laminectomy and foraminotomy if bone spurs or other overgrown or bulging tissues are contributing to nerve compression. The goal of treatment is to minimize lower back pain, resolve sciatica (pain and numbness or tingling that travels into the legs and buttocks) and restore a reasonable level of mobility.

It is important for patients to have reasonable expectations for what this surgery can achieve. Fusion tends to be most successful at resolving sciatica and helping patients return to normal routines (barring high impact activities such as jogging). Lower back pain is often reduced and much more manageable after recovery as well. However, patients who have this lumbar spine surgery tend to continue having more back pain than the average person. Not all patients have relief from their symptoms after surgery.

Who Is a Candidate for Lumbar Fusion?

Lumbar spine surgery today is much less invasive and scary than it was just a few decades ago. Success rates are much higher now and the risk of serious complications is a lot lower. However, lumbar fusion is an irreversible procedure and should only be done under specific circumstances. In the majority of cases of low back pain, patients get better in about six weeks (even if they have no treatment at all). This means most treatments for a “pulled back” or a “pinched nerve” are conservative. A doctor may recommend rest, ice packs, anti-inflammatory medications, cortisone injections and physical therapy exercises depending on the severity and type of symptoms. Lumbar fusion may be considered for patients who meet most or all of the following criteria:

  • Back pain and sciatic symptoms do not resolve after a reasonable period of time
  • Non-invasive therapies do not help relieve symptoms
  • Mobility appears permanently impaired
  • Symptoms get worse over time
  • The patient wishes to be less dependent on heavy-duty pain medications over the long term
  • Test results from x-rays, discogram pain study, CT scans or MRI scans point to a problem that spinal fusion can actually address

 

The medical conditions for which spinal fusion may be recommended include spondylolisthesis (slipped disc), degeneration of the discs associated with aging, spinal stenosis (narrowing of the openings between the vertebrae due to conditions such as arthritis), lumbar fracture and scoliosis.

Only patients who are willing and able to participate in physical therapy at home and with a specialist as instructed by their surgeon are good candidates for this procedure. Failure to follow through with rehabilitation may lead to permanent pain and mobility problems.

Understanding Lumbar Fusion Basics

Fusion always involves at least two of the vertebrae because it fills in or creates a solid bridge of bone that prevents the area between the vertebrae (where the disc is located) from flexing. Sometimes, it is necessary to fuse more than one pair of vertebrae to relieve symptoms and restore function. However, for every joint that is fused, there is additional pressure placed on the vertebrae above and below the fused section. These adjacent sections may become overworked and develop problems of their own in response to the added stress. This increases the risk of future nerve compression, back pain and instability of the spine. This is why it is very important to identify the best joint to fuse to provide maximum relief with minimum side effects.

Procedure Overview

Instead of a long incision, minimally invasive lumbar spine surgery is done through a series of tiny incisions just one to two inches in length on the lower back. Metal dilators (hollow tubes) are inserted into these incisions to gently spread muscle tissue out of the way and provide access to the spine. An endoscope (fiber-optic camera) and other instruments are maneuvered through these incisions to perform the fusion. The actual fusion process involves placing bone graft material between the vertebrae in place of the disc or alongside the vertebrae, attaching one bone to the next like little struts.

The bone tissue used for this procedure may be taken from a site elsewhere on the patient’s body such as the pelvis, or it may be donor bone. Recent advances in biotechnology have also made synthetic bone substitute an option for some patients. Implantable titanium hardware such as rods and screws are often used to provide support for the bone as it heals. These metal pieces may be left in place or removed after the bone has grown strong enough to make the fusion complete.

Risks and Side Effects

Lumbar spine surgery has rare but serious risks of complications including blood clots, excessive bleeding, nerve injury, infection and anesthetic reactions. Obese individuals, smokers and patients with high blood pressure, diabetes or other chronic health conditions may face increased risks during and after surgery. Following all pre and post-operative instructions minimizes the chances of complications and promotes a fuller recovery.

Because bone grows slowly, it can take many months for the fusion to become solid and stable after this procedure. Patients should expect some discomfort after the surgery. This is typically managed with prescription pain medication at first. Most patients will be up and walking within a few hours of the surgery. This is important both for maintaining mobility and for decreasing the risk of complications such as blood clots. Over the following weeks and months, patients add low-impact exercise and stretches into their rehabilitation routine. This progression is based on how well the bones are growing together. Return to work may take weeks or months based on:

  • The extent of the surgery
  • The patient’s rate of healing
  • The nature of the job (sedentary or highly physical)
  • The length of the commute

 

A high percentage of patients who have lumbar spine surgery are able to perform sedentary work and engage in moderate levels of activity including hobbies after recovery. Mobility, comfort and quality of life are typically better than before the surgery for patients who are good candidates for the procedure.

Benefits of Minimally Invasive Lumbar Spine Surgery

This procedure, performed through the back with endoscopic instruments, has similar rates for successful fusion compared to open surgery. However, it can have many advantages over the more invasive open technique. These include:

  • No cutting of the muscles in the back (leading to a more comfortable recovery)
  • Less need for pain medication because of minimal tissue trauma (patients may have the option to get off pain meds sooner)
  • Lower risk of severe bleeding (little chance of needing a blood transfusion)
  • Shorter hospital stay
  • Less noticeable scarring
  • Potential for fewer surgical complications
  • Faster return to daily activities

 

Patients who have heard horror stories about lumbar fusion from friends or family members who had surgery several decades ago should learn all they can about recent advances and options for lumbar spine surgery. Today, success rates and patient satisfaction are much higher – especially with minimally invasive techniques.

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