Understanding Spine Structure
The small bones that make up the spine are called vertebrae. They stack on top of one another in a column with a hollow space at the center, called the spinal canal, that shelters the spinal cord. Each pair of vertebrae is separated by an intervertebral disc that provides cushioning and shock absorption.
The spine’s overall structure is usually very stable. The body relies on this stability to keep the muscles, skeleton, and internal organs supported. Various health conditions, however, can cause the vertebrae to move against one another more than normal. This can stretch the surrounding ligaments and muscles. It may also pinch the spinal cord or root nerves, preventing normal function. This creates pain, numbness, muscle weakness, and even loss of organ function.
What Is Lumbar Fusion Surgery?
Lumbar spinal fusion is a surgical procedure that eliminates problematic movement in the spine. It does this by fusing two or more vertebrae together to create a single sturdy bone. By eliminating movement, spinal fusion effectively eliminates the cause of pain to provide long-lasting relief.
What Does Lumbar Fusion Surgery Treat?
Lumbar spinal fusion is an effective treatment for any form of spinal instability in the lumbar spine, or lower back. There are several different spine conditions that can cause instability, all of which can be treated with lumbar fusion surgery. These include:
- Lumbar degenerative disc disease: Spinal discs wear down over time, becoming shrunken and stiff. Degenerated discs no longer provide sufficient cushioning.
- Lumbar herniated disc: A damaged spinal disc may leak core material into the spinal canal, creating pressure on the spinal cord, or into nearby tissues, irritating them.
- Lumbar spondylolisthesis: Stretched or torn ligaments (lumbar sprain) may allow one vertebra to slide forward over the one below it, causing instability and pain.
- Lumbar spinal fracture: If one or more vertebrae are damaged due to a fracture, then spinal fusion may be necessary to treat the injury and stabilize the spine.
- Lumbar kyphosis: This spinal deformity is caused by excessive curvature in the lower back, creating a hunched appearance. Spinal fusion is used to correct the curve.
- Flat back syndrome: Age-related degeneration can cause the lower back to lose its curvature. Spinal fusion surgery may be used to recreate a healthy spinal curve.
- Lumbar stenosis: Bone spurs can grow from the vertebrae into the spinal canal, where they impinge upon the spinal cord and compress the root nerves.
- Lumbar spine infection: An infection in the spine causes inflammation of soft tissues. The inflamed tissues may compress root nerves or the spinal cord itself.
- Lumbar spine tumor: If a tumor has developed in the spine, it may replace or damage necessary structures. Fusion surgery is used to stabilize the spine after tumor removal.
If a patient is struggling with pain caused by any of the above conditions, they should speak with their physician about lumbar fusion. Surgical treatment is a permanent solution for pain, letting patients get back to leading a higher quality of life.
Who Should Get Lumbar Fusion Surgery?
Though lumbar spinal fusion can treat a wide variety of conditions, it is not the only option – nor is it always the best one. Major surgery is a big step that should always be considered carefully before attempting. Many patients get good results with less invasive surgeries and even conservative treatments, such as:
- Resting
- Making activity modifications
- Doing physical therapy
- Taking over-the-counter (OTC) or prescription pain medications
- Getting steroid injections
- Wearing a brace
Lumbar fusion surgery is most often recommended for patients who have tried other treatments without finding relief, especially when the symptoms are interfering with the patient’s quality of life. Fusion may also be recommended for patients whose spine condition has created severe instability. In these cases, fusion surgery can prevent serious consequences that arise as the spine continues to destabilize.
Who Is Not a Good Candidate for Lumbar Fusion?
Lumbar spine fusion is not typically recommended for patients with poor bone quality due to smoking or osteoporosis. These individuals will be faced with a longer and riskier recovery than other patients. Their vertebrae may also fail to fuse completely, resulting in failed back syndrome and continued pain. Patients can speak with their physician about improving their bone quality in preparation for surgery.
When to See a Doctor
Lower back conditions can have a significant impact on a patient’s quality of life. They make it difficult to work, sleep comfortably, or participate in favorite activities. This can affect the person’s body image, mood, and relationships with friends and family. Patients should always speak with a physician if they are experiencing issues that affect everyday life, such as:
- Lower back pain
- Visible posture changes
- Inability to bend or twist the lower back without pain
- Pain that radiates from the buttocks into the legs (sciatica)
- Tingling or loss of sensation in the buttocks, legs, or feet
- Weakness or loss of muscle control in the legs or feet
- Loss of bowel or bladder control (incontinence)
- Sexual dysfunction or impotence
Speaking with a doctor about treatment is the first step to finding relief. The appropriate medical care can reduce or even eliminate uncomfortable symptoms, helping patients get back to the lifestyle they enjoyed before their spine condition developed.
Planning Lumbar Fusion Surgery
The lumbar fusion process begins with diagnosis and treatment planning. Fusion is an extensive surgery that requires careful planning to treat pain effectively without complications. The surgeon must first pinpoint the precise cause of the patient’s pain. This is accomplished using several diagnostic tests, including:
- Physical examination: The doctor examines the patient’s body, tests their flexibility, and asks questions about how their symptoms impact everyday life.
- Neurological exam: A type of physical exam, this test focuses on evaluating the patient’s nerve function to identify signs of damage or impingement.
- Medical history: The doctor reviews the patient’s medical history to learn more about their overall health and related issues that might affect treatment.
- Medical imaging: A computed tomography (CT) or magnetic resonance imaging (MRI) scan provides detailed images of the patient’s spine to locate the disorder.
- Lab tests: Tests to evaluate blood pressure, clotting, kidney function, and immune response are used to identify factors that may complicate the surgery.
These tests help to rule out potential causes for pain and arrive at a conclusive diagnosis. They also help the surgeon locate the problem and determine the best approach to treating it.
Preparing for the Procedure
After the patient’s condition has been diagnosed and a treatment plan has been devised, they can schedule an appointment for surgery. The surgeon provides instructions for how to prepare. Spinal fusion surgery does not typically require extensive preparation, but there are some steps that patients can take to ensure successful treatment and recovery. These include:
- Arranging transportation to and from the hospital
- Pausing certain medications, like blood thinners
- Quitting nicotine use, including smoking and vaping
- Taking time off work for the procedure and recovery
- Finding somebody to help at home while healing
- Fasting, or stopping food and drink before surgery
Patients should also ask any questions they have regarding their upcoming treatment and recovery. When people understand what to expect from medical treatment, they can approach their procedure with greater confidence and trust in their surgeon’s expertise.
Lumbar Fusion Surgery Approaches
Lumbar fusion surgery can be performed with a few different approaches. This refers to the angle the surgeon uses to access the spine. Doctors at NU-Spine prioritize minimally invasive approaches that provide reliable results with shorter recoveries. The best approach, however, often depends on the patient’s condition and its location in the spine.
Posterior Lumbar Interbody Fusion
During posterior lumbar fusion (PLIF), the physician accesses the spine from the back. This provides the most space, making it ideal for complex or extensive procedures. It also requires the largest incision, however, creating more pain and a lengthy recovery.
Transforaminal Lumbar Interbody Fusion
Transforaminal lumbar interbody fusion (TLIF) involves accessing the spine slightly to one side and working through the foramen, or a narrow hole between vertebrae. This approach requires less movement of the nerve roots, decreasing the chance of nerve injury.
Extreme Lateral Interbody Fusion
Extreme lateral interbody fusion (XLIF) involves accessing the spine from far to one side. This approach avoids major muscles and nerves to reduce damage and surgical stress. It delivers the easiest recovery but is not always an option depending on the patient’s condition.
How Lumbar Fusion Surgery Is Done
Aside from where the incision is made, all three types of lumbar fusion follow a similar process. They are performed under the effects of general anesthesia, meaning that the patient sleeps through the surgery. Medical equipment is used to monitor the patient’s heart rate and blood pressure, and a breathing tube may be placed to help the patient breathe while asleep. The procedure follows these steps:
- The surgeon makes a small incision in the skin. He then pushes aside muscles, nerves, and other soft tissue to access the spine.
- Using precise tools, the surgeon removes the spinal disc.
- The surgeon fills the gap between vertebrae with bone graft material. The graft may be sourced from the patient’s body (autograft) or from a donor bank (allograft).
- The surgeon inserts titanium plates, rods, and screws to anchor the vertebrae.
- The surgeon closes the incision with stitches or staples.
The procedure takes a few hours to complete. It may be longer if the surgeon opted for an autograft. Afterward, the patient is taken to a recovery room to wake up from anesthesia.
Recovery After Lumbar Fusion Surgery
Patients typically have a short hospital stay after surgery. Once the patient is ready to go home, the surgeon provides instructions for recovery. He may instruct the patient to:
- Protect incision sites with surgical dressings
- Avoid bending or twisting movements until the fusion heals
- Take prescription or over-the-counter medications to manage pain
- Take a course of antibiotics to prevent infection
- Monitor for swelling, redness, and other signs of infection
- Walk around daily to promote blood flow for healing
- Eat a diet high in calcium and vitamin D
- Schedule a follow-up appointment
Once the incisions are closed and the site no longer hurts, the patient begins physical therapy to gradually restore their strength and full range of movement. Most patients can resume work and other light activities in one to two weeks. It may be several months, however, before patients are ready to resume strenuous activities. Certain activities should be avoided for up to a year to ensure that bones fuse completely and the spine is fully stabilized.
Choose the Right Lumbar Fusion Surgeon Near You in New Jersey
Lumbar fusion surgery is a proven and permanent solution to some forms of lower back pain. To get the best results, however, it is important for patients to work with the best spine doctor. Treatments at NU-Spine are performed by the award-winning neurosurgeon, Branko Skovrlj, MD. He is world-renowned for his expertise with complex and minimally invasive spine procedures. He also treats patients with compassion, giving them peace of mind that their spine surgery is in good hands.
Transform your life with a touch of care at NU-Spine: The Minimally Invasive Spine Surgery Institute. We provide cutting-edge treatments for patients across the state of New Jersey, helping them return to lives free from pain. Contact us to learn more about our services, including lumbar fusion surgery, or to schedule an appointment at one of our locations near you in New Jersey and begin discussing your treatment.