Anterior Lumbar Fusion
Lumbar fusion is indicated for some back conditions. Generally, all other options are attempted prior to considering a fusion procedure.
In a lumbar fusion, an attempt is made to get two or more separate vertebrae in the spine to grow together and become one solid bone. The procedure can also include other procedures like decompression to open up any spaces that are too tight. The benefit of fusion for many people is that it can correct deformity and prevent further degeneration and deformity at the level or levels that are fused.
When an anterior fusion is performed, an incision is made over the abdomen. The muscles are split in line with their fibers to expose the peritoneal sac which holds the bowels, etc. This is gently moved aside to expose the spine. If any vessels are present on the spine, these are gently retracted.
Preparation for fusion involves creating an environment similar to a fracture which tricks the separate vertebrae into thinking that they need to heal together as one. This often involves scraping the ends of the bones and packing some bone graft into the space which speeds up the process.
Often, instrumentation in the form of an anterior plate or posterior rods and screws are used to provide increased stability and increase fusion rates. The surgical site is then washed out and closed.
The procedure takes an average of 1.5 – 2.0 hours for one level, but can be longer if more levels are to be done. After the surgery, some are allowed to walk with help that same day, but most begin walking the next day.
Hospital and Recovery
Most patients remain in the hospital for 1-2 days and are then allowed to return home or to a rehab center depending on how they are doing.
The postoperative course is as follows:
- Follow up appointments at 3 weeks, 3 months and 6 months with x-rays taken at all but the first visit.
- Extremely light activity for the first 3 months. Special care is taken to avoid twisting, lifting and bending. Lifting maximum is 10 pounds for that time. This is “couch potato” time as less movement means better fusion rates.
- For the first three months after surgery, it is important to get good nutrition. A balanced diet with plenty of protein, calcium and vitamin-D is essential.
- After 3 months, activity restrictions are lessened and you can begin increasing your activity level slowly.
- Physical therapy is helpful for many David W. Stevens, MD (801) 294-7246 individuals to learn the correct way to lift and bend as well as to learn good exercises to keep the low back in good condition. Most times, formal therapy won’t begin for at least 3 months as too much motion too early may inhibit the fusion process.
Risks of Surgery
The risks generally associated with lumbar fusion are fortunately rare, but if one occurs, it can be devastating. The more common, but less severe complications include:
- Infection – Sometimes requires antibiotics alone. Other times may need repeat surgery to wash out the infection.
- Abdominal hernia – Sometimes the muscle closure in the abdominal wall
does not hold and a hernia can form. If this occurs, it may need repair with a general surgeon. - Back pain – The back hurts quite a bit for the first few months, and then generally decreases to a dull ache, but for some, significant back pain at the surgical site can persist.
- Continued leg and/or buttock pain – Sometimes the surgery does not relieve the pain. This can be a sign of nerve damage.
- Hematoma– After a surgery, a collection of fluid can occur at the surgical site. In most cases, this will resolve on its own, but sometimes requires surgical drainage.
- Scarring – All surgeries leave scars. Sometimes, the scarring after a fusion
procedure can be quite painful.
More severe, but fortunately less common risks include:
- Nonunion – If the bones do not knit together properly, sometimes the
surgery must be redone. - Nerve injury – Great care is taken to protect the nerves during surgery, but on occasion the nerve is so traumatized that even slight movement can cause further injury.
- Bowel or vessel injury – This is rare, but can occur during the lateral approach. This can be a life threatening complication and is carefully avoided.
- Paralysis – As the lumbar spine is well below the spinal cord in most people, this would be very rare, but must always be included as a risk in any spinal procedure.
- Retrograde ejaculation – only in males. This can potentially cause sterility, but is an uncommon occurrence.
Many individuals are tired for quite a while after the surgery. Sometimes as long as 6 or 8 months. Most also experience quite a bit of soreness in the low back, especially for the first few months. This back pain gets less and less until it ends up for most a dull ache. Unfortunately, the dull ache is usually present for the rest of one’s life.
Starting about 3 months after surgery, a dedicated exercise program including 3-5 days per week of cardiovascular exercise for at least 30 minutes combined with daily stretching can maintain one’s fitness and decrease the likelihood of problems in the future.
PATIENT REVIEWS
SCHEDULE AN APPOINTMENT
What Can We Do to Ease Your Pain?