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
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.
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.
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.
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.
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.
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
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.
Stephen Saris M.D.
1 Davol Square, Suite 302
Providence, Rhode Island 02903
FAX (401) 453-3533
© Neurosurgery Associates, Inc.