Posterior Lumbar Fusion
Posterior lumbar fusion, also known as arthrodesis, is a surgical procedure performed to join two or more of the lumbar vertebrae (the small bones of the lower back) into one solid bone. This operation is designed to stop mechanical pain, the pain associated with the movement of the affected bones that results in inflammation of the discs and joints. During this surgery, a bone graft is inserted along the side of the vertebrae which will eventually help the bones grow together. The procedure is called a posterior fusion because the surgeon works on the back of the spine.
Reasons for Posterior Lumbar Fusion
Posterior lumbar fusion is commonly performed to treat a variety of spinal conditions affecting the lower back, including:
- Spinal fractures
- Degenerative disc disease
- Radicular pain (down the buttock and thigh)
Other surgical procedures are frequently performed along with lumbar fusion, such as removing bone spurs or repairing herniated discs.
The Posterior Lumbar Surgery DFW Fusion Procedure
During the procedure, performed under general anesthesia, the patient is usually face down on a special operating table. This position not only provides the surgeon with room to operate and increases comfort for the patient, but also lessens the patient's blood loss.
An incision is made in the middle of the lower back to expose the spinal column, and part of the lamina, the bony covering of the spinal canal, is removed. The surgeon also removes any disc fragments or bone spurs impinging on the nerves, and prepares the patient for the fusion by shaving off a layer of bone from the back of the affected vertebrae. This resulting cut surface is receptive to the bone graft that will be attached.
Because the primary goal of a posterior lumbar fusion is to eliminate the mechanical pain and inflammation associated with vertebral movement, the operation basically consists of a type of welding, in which the bone graft, taken either from the patient's own hip (autograft), harvested from a cadaver (allograft) or manufactured (synthetic), is used to stimulate bone growth. Most often, the graft is fixed in place using a combination of screws, rods and plates to keep the vertebrae from moving. Held in place this way, the tissues have a higher success rate of growing together completely and permanently.
Recovery from Posterior Lumber Fusion
Recovery from this surgery takes from 1 to 3 months during which the patient normally undergoes physical rehabilitation and must avoid heavy lifting, bending and twisting.
Anterior lumbar fusion is a surgical procedure performed to alleviate persistent lumbar pain (pain in the lower region of the back) by joining two or more vertebrae with bone grafts. This fusion eliminates the mechanical motion that results in inflammation and pain. Anterior lumbar fusion is performed from the front of the spine through the abdomen. Reasons for performing the procedure from the front of the body include instability of the spine, degenerative disc disease or fracture. During the anterior procedure, the back muscles and nerves are not disturbed. Also, the anterior approach places the spine in compression which is an advantage when trying to establish bone fusion.
Reasons for Anterior Lumbar Fusion
This operation may be performed for any of the following reasons:
- Disc degeneration
- Scoliosis or kyphosis
- Vertebral fracture
- Spinal stenosis
- Spinal instability
Anterior lumbar fusion is only considered when persistent low back pain, often accompanied by radicular pain (pain that radiates down the buttock and thigh), does not respond to more conservative treatments.
The Anterior Lumbar Fusion Procedure
There are often two surgeons involved in this procedure, one neurosurgeon and one general or vascular surgeon. This is because, in addition to the surgical procedure involving the spinal column itself, there is surgical work to be done on the abdomen and possibly on the peritoneum (the large sack that holds the abdominal contents). Moreover, the large blood vessels in the area, the aorta and vena cava, must be retracted during the operation.
Once there is access to the spinal cord, disc tissue is shaved away to remove any spurs or irregularities and to prepare for the bone graft. The newly cut disc is receptive to the graft and the fusion that will now take place. The bone graft may come from the patient's own hip (autograft) from a cadaver (allograft), or be manufactured from artificial materials. The procedure may be performed with one small incision or, with the help of an endoscope, through several one-inch cuts. Surgical hardware is used to the bone graft in place as the fusion takes place.
Recovery from an Anterior Lumbar Fusion
The recovery period after an anterior lumbar fusion is variable, but usually takes a minimum of 3 months. Patients are advised to avoid bending, twisting and heavy lifting during this period to allow the bone graft time to create a permanent fusion. After the bone is fully healed, physical rehabilitation is usually necessary to re-establish muscle strength and flexibility.