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.
Your doctor may recommend lumbar fusion for persistent lumbar back pain, hip pain, or leg pain caused by:
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. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of lumbar fusion?
As with all surgeries, lumbar fusion involves risks and possible complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs and cause a pulmonary embolism.
Infection and septicemia, which is the spread of a local infection to the blood
Potential complications of lumbar fusion
Complications of lumbar fusion include:
Nerve and blood vessel damage
Pain at the graft site
Pseudoarthrosis is a condition in which there is not enough bone formation to support the graft. This complication is more common in people who smoke. If it occurs, a second surgery may be needed to correct it.
Lack of pain relief, worsening of your back pain, or recurrent spinal symptoms
Lumbar fusion for degenerative arthritis is a somewhat controversial area with a limited success rate.
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery
Informing your doctor if you are nursing or if there is any possibility of pregnancy
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my lumbar fusion?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.
You can prepare for a lumbar fusion by:
Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing varies depending on your age, health, and specific procedure. Pre-operative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a brief doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need a lumbar fusion? Are there any other options for treating my condition?
Which type of lumbar fusion procedure will I need?
How long will the surgery take? When will I be able to go home?
What restrictions will I have after the surgery? When can I return to work and other activities?
What kind of assistance will I need at home?
What kind of rehabilitation and physical therapy will I need?
What medications will I need before and after the surgery? How do I take my usual medications?
How will you treat my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my lumbar fusion?
Knowing what to expect can help make your road to recovery after lumbar fusion as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
A hospital stay of three to four days is usually required. Some patients, such as older adults, may need to stay briefly in a rehabilitation facility.
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. Growth of enough new bone to stabilize your spine can take several months. Your doctor will tell you when you are ready to return to work and other activities based on your individual case.
You may need to wear a back brace for several weeks after your surgery. Your doctor will also likely refer you to an exercise rehabilitation program to help you recover. Full recovery takes several months to a year.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery/procedure. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after lumbar fusion. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Calf pain, or swelling of the calf, ankle or foot
Change in alertness, such as passing out, dizziness, unresponsiveness, or confusion
Chest pain, chest tightness, chest pressure, or palpitations
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate or have a bowel movement
Pain that is not controlled by your pain medication, worsening pain, or pain that is different or occurs in a new area, such as in your leg
Unexpected drainage, pus, redness, tenderness or swelling of your incision
Weakness, numbness or difficulty moving a part of your body
How might a lumbar fusion affect my everyday life?
Lumbar fusion may cure your condition or significantly reduce your symptoms so you can lead an active life. For example, lumbar fusion may relieve or lessen your pain and restore strength to your back. However, you may lose some flexibility in your spine. Also, lumbar fusion will not prevent your spine from becoming damaged again. You can help prevent further spine problems by:
Following your doctor’s instructions about how to move, walk, sit and stand
Maintaining a healthy lifestyle, including an appropriate body weight
Practicing good posture
Strengthening your back muscles with exercises as recommended by your healthcare provider
Using proper body mechanics when lifting or carrying objects
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