Lumbar fusion of the lumbar spine is designed to stop the movement at a painful, unstable spinal joint. By linking together (fusing) two or more of the vertebrae, your surgeon is trying to eliminate the motion that occurs within that portion of the spine. Once a segment of the spine is stabilized 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 immobilization 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 injections or tumours.
Why is this surgery suitable for me?
Surgery is an option if:
- painkillers, rest, exercises and injections don’t help
- there is a likelihood of serious complications involving the nerves if left untreated
- when the pain in the back, hips, buttocks and legs is having a profound effect on your quality of life
The aim of the procedure is to reduce the pain in the lower back and legs.
How is it performed?
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 require a minimum one night stay in hospital.
A 10-12cm incision is made into the abdomen. Organs and blood vessels are expertly moved aside by a vascular surgeon, 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.
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%)