PATIENT GUIDE TO ANTERIOR LUMBAR INTERBODY FUSION

Dr. Saris has recommended a procedure called an anterior lumbar interbody fusion. It has been determined that your back pain is likely due to deterioration in the disk in your low back. The recommendation is that this disk be removed and replaced with what is called a "fusion."

PREPARATION
It is important to prepare for this procedure. On the morning before the surgery, you should take a bottle of magnesium citrate that you can buy at most grocery stores. During the entire day before the surgery, you should not eat solid food. Your diet could consist of any liquids, and foods such as Jello and clear soup. This will greatly assist the first part of the operation that will be performed by a surgical colleague of mine.

SURGERY
Usually on the day of the surgery, you will meet with my associate, who is a general surgeon trained to do the first part of the operation. He will review the procedure that you are about to undergo and the benefits and risks associated with this. These include possible complications involving the bowel, arteries, and veins overlying the spine, and other abdominal structures near the front of the spine. The large blood vessels that lead to the legs lie right in front of the spine where the fusion is performed. In many cases, the vessels must be moved aside to perform the surgery. In most research studies of the procedure, injury to blood vessels occurred in only 1% of the cases reviewed.

You will then receive an intravenous and go off to sleep. If we are only removing the diseased disk, the procedure will take approximately three hours. If we are to additionally place pedicle screws into your back, it will take a longer period of time.

After you are asleep, an incision will be made next to the umbilicus (belly button) that is approximately 4 inches long. After the front of the spine has been exposed, I will come in to perform my part of the procedure.

I will likely make an additional, very small (about an inch) incision about 6 inches from your umbilicus (belly button) to remove a small amount of bone. This will be used to aid in a fusion.

The damaged disk is removed. It is then replaced with a device filled with your own bone called a prosthesis. This is approximately the size of a half-dollar, and contains both your own bone and additional materials designed to enhance proper healing of that area. Some prostheses are made of bone, and some from synthetic materials including metal. An example of how one looks on a X-ray is shown below.

FOLLOWING THE SURGERY
The usual hospital stay is 2 days. If, for example, you have your operation on Monday morning, you will generally go home on Wednesday. The amount of pain is moderate, and similar to a pulled stomach muscle. On returning home, your activity level will generally be good.

BENEFITS AND RISKS
The desired benefit is either substantial reduction or elimination of your pain. Our goal is to eliminate prescription painkillers, and replacement with anti-inflammatory medications such as Celebrex or Motrin. Our goal is a return to normal activity. In my experience, and in the medical literature, the success rates vary tremendously. While my goal is to achieve success 100% of the time, a more realistic goal is 80% of the time.

This is a safe procedure. I have performed this procedure for about 2 years, and have had no serious complications. The main risk is during the first part of the procedure in which the important structures in the abdomen are removed from the front of the spine. As in any procedure from appendectomies to open-heart surgery, deaths have been reported; however, for this procedure this is well under 0.1% and in the hundreds (if not over 1,000) in Rhode Island, I have not heard of a single one. The risk of infection is approximately 2%.

The goal of the procedure is to eliminate motion at the site of a diseased disk. This is done with a fusion. In the picture above, you can see two "vertebral" bones separated by the prosthesis. In time, the two bones and the prosthesis become one large bone. That is called the "fusion." The incidence of non-fusion is under 10%. However, if it were to occur, we would consider placing pedicle screws into the spine at a second procedure.

Please call the office if there are any questions about this guide or about your procedure.


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Stephen Saris M.D.

Neurosurgery Associates, Inc.
3 Davol Square, Suite B200
Providence, Rhode Island 02903

(401) 453-3545
FAX (401) 453-3533

email: questions@neurosurgery-associates.com

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