Sarah Lewis, PharmD
What is lumbar fusion?
Lumbar fusion is the surgical joining of two vertebrae in the lumbar spine, or lower back. Your vertebrae are the bones that make up your spine (backbone). Lumbar fusion permanently stops movement between two vertebrae. It is a treatment for a variety of diseases and conditions of your spine.
Most spinal fusions use a bone graft to fuse or join two vertebrae. Your doctor may also use screws, rods or plates to hold your vertebrae in place. Lumbar fusion can potentially help decrease pain and maintain function in a damaged or diseased lumbar spine.
Lumbar fusion is a common, somewhat controversial surgery with serious risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all your treatment choices before having a lumbar fusion.
Types of lumbar fusion
Lumbar fusion procedures generally use bone graft material. This involves placing bone graft material in strips along your vertebrae, in pieces between your vertebrae, or packed into a special cage that goes between your vertebrae. Your body heals the bone around the graft over a period of several months.
Spinal fusion is not immediate with surgery. It takes time for your body to form enough bone around the graft to permanently fuse your vertebrae.
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The types of lumbar fusion procedures include:
Allograft fusion uses a piece of cadaver bone for the bone graft. Allografts come from a bone bank. Allograft fusions require only one incision and cause less pain than an autograft fusion. However, bone fusion and healing is less predictable with an allograft.
Autograft fusion uses a piece of your own bone for the bone graft. Your doctor will usually take bone from your pelvis. This type of lumbar fusion was the only option available in the past. However, an autograft requires an additional incision, lengthens surgery time, and causes more post-operative pain.
Synthetic, or artificial graft fusion uses synthetic (totally man-made) materials and modified natural bone. Some artificial bone graft materials are used alone and others are combined with an allograft or autograft.
Other procedures that may be performed
Your doctor may perform other procedures in addition to lumbar fusion. These procedures are usually done first and include:
Discectomy is the surgical removal of part or all of a spinal disc. A discectomy treats degenerated, herniated or ruptured spinal discs.
Foraminotomy is the widening of the opening where the nerve roots leave the spinal canal. Your doctor may use this procedure when the opening (foramina) is narrowed causing pressure on the spinal nerves.
Laminectomy is the removal of a bony area called the lamina. The lamina is the back part of each vertebra of your spine. A laminectomy makes your spinal canal larger. This reduces pressure in your spinal canal and your spinal nerves.
Why is lumbar fusion performed?
Your doctor may recommend a lumbar fusion to treat certain diseases and conditions of the spine. Your doctor may only consider lumbar fusion if other treatment options with less risk of complications are ineffective. Ask your doctor about all your treatment options and consider getting a second opinion before deciding on a lumbar fusion.
Arthritis, which is inflammation of the joints that can also affect the joints between vertebrae in the spine
Congenital back deformities, which are deformities present at birth
Degenerative disc disease, a breakdown of the cushioning discs between the vertebrae, which can lead to compression of the spinal cord and nerves
Fracture of a vertebra
Infections of the spine
Scoliosis, an abnormal curvature of the spine
Spinal instability due to a loss or deterioration of muscles, ligaments and discs that support the spine
Spinal stenosis, which is a narrowing of the spinal column causing pressure on the spinal cord and nerves
Spondylolisthesis, which is displacement of one vertebra over the one below it
Tumors of the spine
Who performs lumbar fusion?
An orthopedic surgeon or a neurosurgeon performs lumbar fusion. An orthopedic surgeon specializes in surgical treatment of diseases and conditions of the muscles and bones, including the spine. A neurosurgeon is a doctor who specializes in the surgical treatment of diseases and conditions of the nervous system, including the nerves of the spine.
How is lumbar fusion performed?
Your lumbar fusion will be performed in a hospital or surgical center. The surgery involves placing a bone graft material in strips along your vertebrae, in pieces between your vertebrae, or packed into a special cage that goes between your vertebrae.
Surgical approaches to lumbar fusion
Lumbar fusion surgery is performed using one of the following approaches:
Minimally invasive surgery involves inserting special instruments and an arthroscope through small incisions in your back. An arthroscope is a thin, lighted instrument with a small camera. The camera transmits pictures of the inside of your body to a video screen viewed by your doctor while performing surgery. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less damage to tissues. Your surgeon will make small incisions instead of a larger one used in open surgery. Surgical tools are threaded around muscles and tissues instead of cutting through or displacing them as in open surgery.
Open surgery involves making a large incision in your back (posterior approach), abdomen (anterior approach), or side (lateral approach). Open surgery allows your surgeon to directly view and access the surgical area. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients.
Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different lumbar fusion procedures and ask why your surgeon will use a particular type for you.
Types of anesthesia that may be used
Your surgeon will perform lumbar fusion using general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain.
You may also have a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.
What to expect the day of your lumbar fusion
The day of your surgery, you can generally expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. You care team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will receive.
A surgical team member will start an intravenous (IV) line.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
The surgical team will monitor your vital signs and other critical body functions. Th