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 at least three hours of surgery, and
several months of recuperation before the final result has been
There is no special preparation for this procedure. You should
have nothing to eat after midnight of the evening before your surgery.
If you take medications in the morning, you should do so with a
sip of water before leaving for the hospital. There is no special
cleansing of the back that should be performed prior to this operation.
the day of your surgery, you will be escorted to a part of the operating
room called the "holding area." An intravenous line will
be started, and you will meet with the anesthesia staff and me.
I will ask you if there are any questions, and we will sign a consent
form together. You will then be wheeled into the Operating Room
at which time you will drift off to sleep.
The incision required
for the procedure is about the length of your ring finger, though
we will minimize it as much as possible. The first
part of the procedure involves finding if any nerves
are pinched. This is done in as minimally invasive manner as possible,
and sometimes under an operating microscope. 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 sciatica you may have.
part of the procedure is called the instrumentation.
Four screws are placed, two on each side. These are secured with
metal rods approximately the diameter of a pencil. As soon as these
are placed, the two bones that are either slipping on one another,
or are connected by a degenerated disk, are secured to each another.
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 bone that is placed
is a combination of what we had taken earlier in the procedure,
and a special material to stimulate the bridging of bone from one
vertebral segment to the other. 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 disk 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 procedure is closing the incision that
we have made. 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 internal
bleeding 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 that is noticeable when they twist,
such as when getting into and out of a car. 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. This may require narcotics such as Percocet or Vicodin. We
will do our best to keep you comfortable during this time.
average length of stay in the hospital is one night. We will encourage
you to stand up and walk on the day after the surgery, and progressively
become more active after that.
RECOVERY AT HOME
Recovery from a lumbar fusion requires several months. You should
be able to walk and function independently at home by the time of
your arrival from the hospital. Three days after the surgery, you
may take a shower and the incision may get wet. We encourage you
to keep it covered with a bandage when you are not in a shower until
we see you in the office in a week or so after your surgery.
You begin driving a few
days after the surgery. We encourage relatively short, reasonable
distances. In regard to returning to work, the standard for a "white
collar" form of employment is a return in four to six weeks.
Return to a more physically demanding job such as driving a truck
or heavy lifting generally requires two to three months.
We do not recommend braces.They
have never been shown to help in your recovery. Sitting in straight
chairs with arms is recommended. Avoid low, soft chairs. Walking
is the best exercise. Begin slowly and work up to several miles
a day. You may use a cane if you wish. Do not lift anything heavier
than 5 pounds for the first week. No heavy shoulder-bags, handbags
You may assume any position
that is comfortable in bed. You may begin sexual activity when comfortable.
Pregnancy should be avoided during the first year after this surgery.
I will try to call you at home a day or two after your discharge
to answer any questions that may have arisen. We will then see you
in the office approximately 2 weeks after the surgery to make sure
that the operation is healing well. X-rays are approximately three
months, six months, and 12 months after the surgery. Please bear
in mind that the fusion takes a minimum of three to six months to
solidify and for the two vertebral levels to begin to turn into
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 or failure 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 painkillers. You may need to remain on anti-inflammatory
medications such as Bextra or Celebrex indefinitely. 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 can generally be treated with antibiotics
or simply good hygiene to the affected areas. The risk of a serious
medical complication such as heart attack or death from the
anesthesia or other cause is less than 1 in 100,000.
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 MR imaging of
both the back and elsewhere in the body in the future. In my career,
I have had only one screw breakage, though others have reported
this. It is also possible that the screws can back out of the bone;
however, this has not happened in my experience. The titanium rods
can also become loose or fracture, though I have not seen this in
my over 10 years of performing instrumented spinal procedures.
first priority in placing the screws is to securely seat them in
the bone. The second priority is to avoid hitting 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 a damaged nerve that could cause permanent pain or weakness.
A second operation to re-position the screw might be needed. In
my many years of doing this procedure, to my knowledge I have not
damaged a nerve in this manner on even a single occasion.
A membrane called the
dura covers the nerve and lower spinal cord. During placement of
screws, or unpinching of the nerves, we will sometimes uncover small
holes in the dura from which spinal fluid can leak. This problem,
called a "CSF leak" will usually over on its own,
but on rare occasion will require another operation for its repair.
If there are any questions,
please do not hesitate to contact our staff. This is an extensive
operation with a prolonged recovery. You should make your decision
carefully. If you wish to discuss it further, please call my office
to either talk with me or set up another appointment.
Stephen Saris M.D.