Lumbar Spinal Fusion

Overview

Lumbar spinal fusion is a surgical procedure that permanently connects two or more vertebrae in the lower back to eliminate motion between them. The procedure may be used to treat conditions causing spinal instability or pain, including degenerative disc disease, spondylolisthesis, or spinal stenosis with instability. Fusion may be performed using various approaches and techniques.

Indications

This procedure may be considered when:

• •Spondylolisthesis (vertebral slippage) causing instability and symptoms
• •Degenerative disc disease with significant pain unresponsive to conservative treatment
• •Spinal stenosis requiring decompression with concurrent instability
• •Recurrent disc herniation with segmental instability
• •Spinal deformity such as scoliosis or kyphosis requiring correction
• •Spinal fractures or tumors requiring stabilization
• •Failed prior spine surgery with instability

How It Works

The procedure typically involves several coordinated steps:

• •Preoperative evaluation includes imaging studies, medical optimization, and surgical planning
• •The procedure is performed under general anesthesia
• •Various surgical approaches may be used: posterior (from the back), anterior (from the front), or lateral (from the side)
• •The damaged disc may be partially or completely removed
• •Bone graft material is placed between the vertebrae to promote fusion
• •Hardware such as screws, rods, plates, or cages may be used to stabilize the spine during healing
• •The bone graft may come from the patient (autograft), a donor (allograft), or synthetic materials
• •Over time, the bone graft grows and fuses the vertebrae into a single solid segment
• •Minimally invasive techniques may be used in appropriate cases to reduce tissue damage

Risks

As with any surgical procedure, potential risks include:

• •Failure of the bones to fuse (pseudarthrosis)
• •Hardware failure, loosening, or malposition
• •Infection (superficial or deep)
• •Blood loss requiring transfusion
• •Nerve injury causing numbness, weakness, or pain
• •Dural tear with cerebrospinal fluid leak
• •Adjacent segment disease (degeneration of levels above or below the fusion)
• •Persistent pain despite fusion
• •Blood clots in the legs or lungs
• •Medical complications related to anesthesia or prolonged surgery

Recovery Expectations

Recovery follows a gradual progression:

• •Hospital stay typically ranges from 1 to 4 days depending on the extent of surgery and approach
• •Walking is usually encouraged within 24 hours of surgery
• •A brace may be recommended to limit motion during initial healing
• •Activity restrictions including no bending, lifting, or twisting are typically prescribed for several weeks to months
• •Pain management may include medications and physical modalities
• •Physical therapy is often initiated after initial healing, typically 6 to 12 weeks after surgery
• •Return to desk work may occur in 4 to 8 weeks for some patients
• •Bone fusion typically requires 3 to 6 months, though may require up to a year
• •Full recovery and return to normal activities may require 6 to 12 months or longer

Alternatives

Depending on individual circumstances, alternatives may include:

• •Continued conservative management including physical therapy, medications, and injections
• •Epidural steroid injections or facet joint injections
• •Decompression surgery alone (without fusion) when instability is not present
• •Artificial disc replacement for selected patients with degenerative disc disease
• •Radiofrequency ablation for facet-mediated pain
• •Pain management and rehabilitation programs

Sources

• AAOS OrthoInfo – Spinal Fusion
• Mayo Clinic – Spinal Fusion
• NIH MedlinePlus – Spinal Fusion
• Cleveland Clinic – Spinal Fusion