What is a lumbar fusion?
Spinal fusion surgery is performed to stabilise a spinal segment. Indications vary depending on the underlying pathology. Degenerative conditions is the most common indication but spinal fusion is also performed for instability due to tumours and trauma. A fusion refers to the bony union, spinal instrumentation is used to stabilise the levels until bony union forms. Bone graft can be either from the patient’s own bone, donor bone or artificial bone substitutes. A fusion can be posterior (bone packed around the back of the vertebra) or can be interbody. This means the disc is removed and replaced with bone. Depending on the approach it can be either posterior (PLIF) from the side (TLIF) or from the front (ALIF).
The patient is placed under general anaesthetic and the surgical site is sterilised before the procedure. An incision is made along the midline of the back and the muscles to both sides are dissected from the lamina. Screws are placed into the vertebral body under x-rays to ensure accurate placement. The lamina is removed so as to provide a clear vision of the nerve roots. Further trimming of facet joints may be necessary to provide more room for the nerve roots. In the case of an interbody fusion the disc (cushion) is removed and this space the packed with bone of a substitute. The screws are connected with rods to stop movement over the segment. In cases of severe osteoporosis cement augmentation of the screws are performed to prevent loosening.
Smoking must be stopped for a significant period of time before and after your procedure. This is to ensure optimum bone union. A failed union will result in screw loosening. It will take approximately 6 weeks to make a full recovery. Most patients are in hospital for a week. No driving is permitted for a month post-op. I encourage patients to mobilise by walking as much as possible. The risk of screw loosening or damage is extremely unlikely. Physiotherapy is started in hospital and continued post-op as needed. Older patients have the option of attending a step down facility which is usually fully covered by the medical aids if further rehabilitation is needed.