Lumbar Fusion

Lumbar spinal fusion is a surgery that joins 2 or more spinal bones to correct instability of the spine. Many patients try nonsurgical treatments before they progress to lumbar fusion. However, if your symptoms are caused by an unstable spine, lumbar spinal fusion is probably your only effective treatment option. If you get the surgery and then follow your prescribed rehabilitation plan, you may be able to get relief from spinal pain. Learn more about spinal fusion.

Lumbar spinal fusion is a surgery to join 2 or more spinal bones (vertebrae) so that they eventually grow into 1 solid bone. The surgery is usually done to correct instability of the spine.

Arthritis, injuries, or simple wear and tear can cause some of the bones in your spine to slip or shift out of place. This abnormal bone movement can cause back pain. It can also pinch nerves, causing pain, numbness, or weakness in your legs. The leg pain is called sciatica [sy-AH-tik-uh] or radiculopathy [ruh-dik-yuh-LOP-uh-thee]. The goal of spinal fusion surgery is to stop abnormal movement and thus eliminate pain in your back and legs.

Spinal fusion surgery is usually done after non-surgical treatment options have failed.

These can include:

• Medicines
• Physical therapy
• Traction
• Spinal injections
• Watching and waiting

If your symptoms are caused by an unstable spine, lumbar spinal fusion is probably your only effective treatment option. If you feel your symptoms are not severe enough to have surgery, tell your doctor. They will respect your decision.

Like with any surgery, there are some risks and side effects with spinal fusion, including:

• Blood loss. There is always the potential for life-threatening blood loss, but with current techniques, this is rare.
• Damage to the nerve sac, with leak of spinal fluid (2 to 5 people out of 100 cases). If the nerve sac is unintentionally opened during surgery, it will be repaired. This should not have any effect on your long-term outcome, but you may have to spend a day or 2 flat in bed to allow the repair to strengthen. Rarely, further treatment may be necessary.
• Infection (1 or 2 people out of 100 cases). Even with antibiotics and careful sterile technique, there is still a small risk of developing a wound infection.
• Damage to spinal nerves (fewer than 1 person out of 1,000 cases). This could cause ongoing pain, numbness, or weakness in your legs.
• Failure of fusion. If the fusion fails, you may need to have more surgery.
• Failure to relieve symptoms. Your surgeon will do everything possible to give you the best results. Even so, surgery may not relieve all your symptoms.

Spinal fusion may eliminate pain by stopping abnormal and painful movement between diseased vertebrae. It is typically done after patients have tried nonsurgical treatments and not had lasting pain relief.

Take these steps to help make your surgery and recovery go better:

• Stop smoking. If you smoke, try to stop prior to surgery. Non-smokers have fewer complications related to surgery. More importantly, smoking slows bone healing, and could cause your fusion surgery to fail.
• Stop certain medicines. Stop taking aspirin 2 weeks before surgery. Stop taking anti-inflammatory medicines, such as ibuprofen (Advil, Motrin) and naproxen (Aleve), 1 week before surgery. If you take blood thinners, ask your doctor when to stop taking them. You can continue to take most of your other regular medicines. Tell your doctor about everything you take including over-the-counter medicines, supplements, inhalers, liquid medicines, and patches.
• Ask for time off work. Ask your doctor how long you may need to be off work, and make arrangements with your employer.
• Ask for someone to drive you home. Arrange for someone to drive you home from the hospital and help you at home for the first few days.

Before surgery, be sure to:

• Follow your doctors instructions about when to stop eating or drinking before surgery.
• Take your regular medicines (as directed by your surgeon), as normal, with a few sips of water.
• Come prepared to be admitted to the hospital on the day of the surgery.
• Bring a list of all your current medicines with you to the hospital.

You may need to fill out some paperwork, including a consent form for the surgery.

Here’s what to expect during your procedure:

1. An anesthesiologist will put you to sleep so you will not feel or remember the surgery. You will also be given antibiotics to help prevent infection.
2. You will be placed on your stomach so the surgery can be done from your back, at or near your spine.
3. After making an incision (cut) in your skin and spine, the surgeon will implant fixation devices to hold the vertebrae in the correct position. These devices (called “hardware”) include spacers in the disc space between the bones and a system of metal (titanium) screws and rods on the back of the bones.
4. If spinal nerves are pinched by disc material, overgrown joints, or bone spurs, the surgeon will remove that material to ensure that the nerves have plenty of space.
5. The surgeon will then pack bone chips between and around the abnormal vertebrae so that over time they will fuse (grow together) into a solid piece of bone.
6. The incision will be closed with stitches or staples.

Getting results from spinal fusion surgery usually takes longer than other types of back surgeries. Your activity will be restricted for at least 6 weeks after the procedure until your surgeon can see bone regrowth in x-rays. Many patients can ease back into activity 3 to 4 months after the surgery, but it may take up to a year for your spinal bones to completely heal.

After surgery, your doctor will work with you to make a plan for follow-up rehabilitation and exercise. Staying active with light, gentle exercise is important and can deliver many benefits. As you follow your prescribed physical therapy program, you will have the best prospects for recovering from the fusion and have the best possibility for pain relief over the long term.

Here’s what to expect after surgery and during recovery:

• You will wake up from surgery in a recovery area of the hospital. Within about 30 minutes, you will be taken to your hospital room.
• You will feel new pain in the area where the surgery was done. The first few days after surgery can be quite painful. You’ll be given medicine for it, and the pain will gradually go away.
• Most patients are up and walking the day of the surgery. Nurses and physical therapists will be there to help you. By the time you are released from the hospital, you should be able to get around on your own, go up and down stairs, and take care of your own personal needs.
• Expect to stay in the hospital for several days. Some patients need to stay longer. You will be allowed to go home as soon as you’re doing well medically and your surgeon approves.