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 make one bone. This procedure requires approximately three hours, and months of recuperation before the final result has been achieved.

PREPARATION: You will be asked to shower using a special soap the night before 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.

THE PROCEDURE: When you come into the Operating Room, you will first enter the Holding Area. You will meet with me, 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.

We will roll you gently onto your belly. An incision is made in your low back, generally the length of your ring finger. Two large muscles are moved aside to expose the back or your spine (see picture at left). They often spasm up after the operation which will make up most of your discomfort.

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 sciatica you may have.

The second part of the procedure is called the instrumentation. Screws are placed on each side (see picture at right). These are secured with metal rods approximately the diameter of a pencil. The two bones that are either slipping on one another, or are connected by a degenerated disc, are secured to each other. The position of these screws is carefully checked with X-rays at the time they are placed.

The third part of the procedure is called fusion. We often remove the degenerated disk between the spine bones (vertebra) and replace it with a spacer such that the two bones will grow together to make one bone.

The final part of the procedure is closing the incision. The muscles that we pushed aside are gently put back. 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, and will generally be removed the day after the surgery.

POSTOPERATIVE CARE: 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 2 nights.

RECOVERY AT HOME: Recovery from a lumbar fusion requires several months. You should expect a fair amount of pain from the surgery itself, but only for 1-2 weeks.

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 may be started, and your back pain will begin to improve. You will then be seen at about 3, 6 and 12 months after surgery.

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%, and can take a full year. 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 healed or if any other issues are present.

This is a safe surgical procedure and the risk is minimal. Many of our patients are still concerned about paralysis or needing a wheelchair. There is no chance of this as your procedure is not even close to the spinal cord. The most common risk is infection (approximately 2%). This is usually mild and treated with oral antibiotics. The next most common risk is a CSF leak. A membrane called the dura covers the nerves. During surgery, we sometimes see a pinhole in the dura from which spinal fluid can leak. This is repaired at the time of surgery.

Please do not hesitate to contact us with any questions.

ssaris@bwh.harvard.edu

roddcasper@gmail.com