Lumbar Spinal Fusion
Lumbar spinal fusion is a technique by where we will trick the bones of the spine to think they are broken and need to fuse together. We’ll do this by roughing up some of the bone edges and applying rods and screws for added stability, as well as bone grafts both from the patient and a cadaver to aid in the process of getting those two bones to grow together.
The benefit to patients who have lumbar spinal fusion is that, if chosen appropriately, they can get fairly rapid relief of their leg symptoms as well as their back pain. And unlike some of the nonoperative treatment measures, it can lead to a more permanent fix at that fusion level.
The decision to perform lumbar spinal fusion surgery rests on a number of factors. Most importantly, the patient has to have the appropriate indication for spinal surgery—that being either spinal instability, or a large spinal curve or scoliosis. But then, prior to even considering that spinal surgery, they need to have exhausted all nonoperative treatments, including physical therapy, weight loss and interventional techniques such as epidural injections. If they’ve tried those treatments, and the pain is still significantly inhibiting their quality of life, only at that point do we then discuss surgical options to treat their disease.
After surgery, I will limit patients’ movements for three months, and I ask them to avoid the extremes of bending and lifting and twisting. Now, I know you can’t live your life without those things, but it’s really just more of a reminder that, “Hey, if I drop a pin on the ground, maybe I don’t bend over to pick it up, or I don’t try to look behind me or twist the whole way.” You can twist enough to perform personal hygiene, but it’s really just a reminder to try not to do too much in that initial post-operative period.
Physical therapy is involved in the initial phases in the hospital to ensure that patients are, in fact, safe to go home. But the physical therapy that most people think about – where we’re talking about strengthening of the core and that sort of thing – that doesn’t occur until about three months after surgery, after we’ve allowed the bonding to heal, and the cells in that fusion area are on the pathway to forming new bone.
The advice that I would offer any patient who is undergoing lumbar spinal fusion surgery, or any spine surgery, is that they need to feel they have exhausted all of the nonoperative treatment options, and that their symptoms are really inhibiting their quality of life and the things they enjoy doing. At that point, I think you can have an understanding and take on the risk involved with spine surgery.
I encourage you to watch Lumbar Spinal Fusion: A Patient’s Story to learn more about the procedure from the patient perspective.