What Is a Lumbar Fusion?

Lumbar fusion surgery – Lumbar fusion of the spine is designed to stop the movement at a painful, unstable spinal joint. The procedure can be performed at any painful region of the spine. By joining (fusing) two or more of the vertebrae, the motion that occurs within that portion of the spine is halted. The fusion prevents nerves from rubbing on the disc and stops the inflammation that occurs from rubbing bones, facet joints or nerves. Once a segment of the spine is stabilised the patient usually experiences some relief of pain. The surgeon may opt to use specialised spinal instruments (screws, rods, plates) to immobilize the spine, this immobilisation will enhance the healing process. Spinal instrumentation acts as an internal splint.

Surgeons use this procedure when patients have spinal vertebrae injuries, protrusion and degeneration of the discs, curvature of the spine or a weak spine caused by infections or tumours.

Mr Mo Akmal is a specialist in Lumbar Fusion surgery through a keyhole approach.

Who Needs This Surgery

Anyone with chronic pain due to spondylosis, scoliosis, fracture or disc degeneration could benefit from the decompression and fusion of spinal vertebrae. Once conservative treatment has been attempted, the patient and doctor should assess whether stretching and strengthening exercises will solve the problem without surgery. If these conservative treatments are  insufficient and the patient needs relief from debilitating arm or leg pain, a spinal decompression and fusion procedure may be recommended.  A fusion is generally only performed in the setting of instability or deformity.

Surgery is an option if:

1. painkillers, rest, exercises and injections don’t help
2. there is a likelihood of serious complications involving the nerves if left untreated
3. when the pain in the back, hips, buttocks and legs is having a profound effect on your quality of life
4. The aim of the procedure is to reduce the pain in the lower back and legs.

How to Prepare

The week before your surgery, you will have some blood tests and spinal X-rays if you haven’t had any recently.

Your doctor may wish to go through the main points of your procedure. Do not be afraid to raise queries if you don’t understand anything. Your MD needs you to be ready.

Here are some things to do before your surgery:

• You will need someone to drive you and take you home.
• Get an inventory of the medicines you’ll be able to or can’t absorb the times before surgery. Some drugs, like painkiller or different medications.
• Find out if you’ll be able to eat or drink something before your procedure.

Lumbar fusion can be carried out with an anterior (from the front) approach or a posterior (from the back) approach. Your surgeon will determine which approach is the best method for you. An anterior approach does carry a slightly higher risk of complication, but generally gives a better result and quicker healing time. Both procedures are performed under general anaesthetic and sometimes be done as day surgery but usually require a one night stay in hospital.

Anterior approach

A 10-12cm incision is made into the abdomen. Organs and blood vessels are expertly moved aside by thesurgeon, revealing the front of the lumbar spine. The degenerate discs are carefully removed and replaced with a spacer. The spacer may be a fusion cage or a prosthetic disc replacement. If a cage is used, it is filled with synthetic bone material (bone putty) and then inserted into disc space. The cage holds the upper and lower vertebra tightly together, while the bone material aids to fuse it all together. Screws may also be fixed in place to keep it all secure and stable.

Posterior approach

A 10-12cm incision is made into the back. They surgeon must cut through layers of muscle to reach the spine. The degenerate discs are carefully removed and replaced with a spacer. The spacer may be a fusion cage or a prosthetic disc replacement. If a cage is used, it is filled with synthetic bone material (bone putty) and then inserted into disc space. The cage holds the upper and lower vertebra tightly together, while the bone material aids to fuse it all together. Screws may also be fixed in place to keep it all secure and stable.

What are the risks?

• infection of your wound after surgery, which is not usually serious and can be treated with antibiotics (deeper spinal infection is more serious but very rare) (2-3%)
• damage to nerves and blood vessels, which occurs in rare cases (1%)
• paralysis, which means loss of use of the legs, loss of sensation and loss of control of bowels and bladder is low (1%)
• implant failure, if the body rejects the implant, a further operation may be required. Alternatively if the implant moves and press on the nerves, the initial symptoms may return
• failure of fusion, if the bones fail to fuse together, neck pain can recur and a further operation may be considered (15%)
• rare complications associated with general anaesthetic, such as heart attack, blood clot in the lung or an allergic reaction
• dural tear (tear in the tissue covering the spinal cord), which if damaged during surgery can easily be repaired with no significant side effects. If this does not heal itself, then a further operation may be required (6%)

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