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PATIENT GUIDE TO LUMBAR FUSION

An operation has been recommended to you that is called a LUMBAR FUSION. This is a surgical procedure that secures two spinal bones (vertebrae) to one another to, in effect, make one bone. This procedure requires approximately three hours of surgery, and several months of recuperation before the final result has been achieved.

PREPARATION: You will be asked to shower using a special soap, the night before or the morning of the surgery. It will be given to you by the hospital at your pre-operative evaluation. You should not eat or drink anything after midnight before the day of the surgery. You will be instructed if you need to stop any medications prior to your surgery by our office staff, and which medications to take the morning of your procedure, by the nurse at your pre-operative appointment.

THE PROCEDURE: When you come into the Operating Room, you will first enter the Holding Area. You will meet the nursing staff, the anesthesia staff, and have an intravenous placed. You will then be wheeled into the Operating Room and be given a medication that will allow you to drift off to sleep.

After you are asleep, you will be rolled gently onto your belly. After the correct level of your spine is identified by x-ray, an incision will is made in your low back. Muscle is pushed aside (retracted) to expose the back or your spine. The first part of the procedure involves unpinching any nerves that are affected. During this part of the operation, we use a natural opening to enter into the back of the spine. This gives us access to the nerves so that they can be freed up to eliminate any radiating leg pain you may have.

The second part of the procedure is called the instrumentation. Screws are placed on each side. These are secured with metal rods approximately the diameter of a pencil and the length of your small finger. The two bones that are either slipping on one another, or are connected by a degenerated disc, are thereby secured to each other. The position of these screws is carefully checked with X-rays at the time they are placed.

The third part of the procedure is called fusion. Although the rods and screws are extremely strong, they have the potential to loosen over time. To ensure that the bones are secured to one another throughout your lifetime, bone is placed that will grow from one vertebra to the other, creating a strong bridge that will last forever. The material that is placed is a combination of your bone that we had removed earlier in the procedure, and a special material to stimulate bone growth. In essence, the two bones will grow together to make one bone.

At the time of surgery, we will make the determination as to whether the worn out disc should be removed and replaced with a piece of bone to make the fusion even stronger. This is called a posterior lumbar interbody fusion. If we can safely carry this out, we will do so.

The final part of the procedureis closing the incision that we have made. The muscles that we separated are allowed to settle back into place. The skin is closed either with a surgical glue or with stitches. We usually place what is called a drain. This is a small tube that travels from the area of the operation to a small container that will be outside your body. This is to prevent blood from accumulating around the surgical area that could cause problems. This will generally be removed the day after the surgery.

POSTOPERATIVE CARE: This is an extensive procedure that should be viewed in a manner similar to a hip or knee replacement. It is a several hour surgery, and a several month recovery. The amount of back pain that is experienced after surgery is highly variable. Some patients feel little more than a moderate muscle pull. Other patients have more extensive pain requiring strong medication. You can expect at least two weeks of pain sufficient to limit your activity at home. We will do our best to keep you comfortable during this time.The average length of stay in the hospital is 1-2 nights.

RECOVERY AT HOME: Recovery from a lumbar fusion requires several months. The back pain for the first couple of weeks can be significant. In general, you will be seen about 2 weeks after the surgery, to check the incision and to make sure that all is healing well. Physical therapy will be started, and your back pain will begin to improve. You will then be seen about 4-6 weeks later, to ensure that the therapy is working. Your third visit will be about 3 months after surgery, at which time x-rays will be taken to look at how the fusion is progressing. You may be seen at 6 and 12 months after surgery, again to assess the fusion. For a blue-collar type of job, we will try to get you back to work in about 10 weeks. For a white-collar type of job, we can usually get you back to work in about 3 weeks.

BENEFITS AND RISKS: All operations have benefits and risks. The benefit is to improve your back and leg pain. The success rate is approximately 80%. This determination of success is generally made six months from the time of the surgical procedure. We are hopeful that you will have minimal or no pain, and will be able to discontinue all prescription pain medications. Approximately 20% of the time, even when all has healed well, there is no pain relief. In this event, we would evaluate whether the fusion has solidified or if any other issues are present.

This is a safe surgical procedure. Many of our patients are still concerned about paralysis or needing a wheelchair. There is no chance of this as your procedure is not close to the spinal cord. The most common risk is infection (approximately 2%). This is usually mild can generally be treated with oral antibiotics. If an infection travels down to the area of the surgery, treatment may require another procedure and intravenous antibiotics. In an overwhelming majority of cases, the blood loss is minor and well-tolerated, and transfusions are not required. A membrane called the dura covers the nerve and lower spinal cord. During placement of screws, or unpinching of the nerves, we will sometimes see a small hole in the dura from which spinal fluid can leak. This problem is called a "CSF leak." This will be repaired at the time of surgery and generally heals without incident, but on a rare occasion, will require another operation for repair.

The screws and rods that we place are made of a metal called titanium. This is extremely strong, and fortunately will allow you to undergo an MRI of both the back and elsewhere in the body in the future. There is a risk of screw or rod breakage, or the screws can back out of the bone. The risk of either is extremely low.

The first priority in placing the screws is to securely seat them in the bone. The second priority is to avoid contacting the nerves that are only a fraction of an inch away. We have many ways of doing this. The most important is that the screws are carefully monitored with an X-ray machine called a fluoroscope. We also sometimes use a technique called "stimulation" to make certain that the nerves are safe. Nonetheless, at times the screws can loosen or move, or the fluoroscope could be misleading. This could result in nerve damage that could cause permanent pain or weakness. A second operation to re-position the screw might be needed.

Either the physician assistant or I are always available, 24 hours a day, 7 days a week, if there are any questions or concerns after your surgery.


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Stephen Saris M.D.

Neurosurgery Associates, Inc.
1 Davol Square, Suite 302
Providence, Rhode Island 02903


(401) 453-3545

FAX (401) 453-3533

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Neurosurgery Associates
Neurosurgery Associates