Lumbar fusion (Arthrodesis) is a major surgery performed to permanently join together two or more bones in the spine so there is no movement between them. These bones are called vertebrae. A lumbar fusion surgery is designed to stop the motion at a painful vertebral segment, which in turn should decrease pain generated from the joint. There are many approaches to lumbar spinal fusion surgery.
There are several different techniques used to fuse the spine. In the anterior technique the surgeon approaches the spine from the front. This requires an incision in the lower abdomen. For the posterior approach the incision is from the back. Sometimes, approach from the side is also attempted known as lateral approach. Minimally invasive techniques are developed to perform fusions with smaller incisions.The surgeon will decide and determine the approach based on the depend on the nature and location of the disease for each patient.
All spinal fusions require bone material, called a bone graft, to aid the fusion. Generally, small pieces of bone are placed into the space between the vertebrae to be fused. this is known as bone grafting.
A bone graft stimulates bone healing and increases bone production. This integrates the vertebrae to heal together into a solid bone mass. Solid pieces of large sizes are also used to provide immediate structural support to the vertebrae. The autologous graft from the patient’s own hip bone have been used for decades as the option for fusing the vertebrae. As this requires another incision from grafting of the bone this procedure lengthening the surgery time and increases pain and discomfort for the patients, this traditional method is no more popular. Allograft or cadaver graft are also available and are used if required. Artificial bone graft are known to safe, effective and are the most popularly used . Bone-forming proteins and minerals are also used as filler to promote solid bone mass depending on the condition of the patient, type, location and severity of the disease the surgeon will determine the type of surgical approach and the use of bone grafts and fillers.
A decompression surgery relieves nerve pain by making more space around the spinal cord and nerve roots. A second advantage of fusion is that it reduces post-decompressed deformity. Similarly, a fusion can correct any deformity the patient had before surgery and ensure that the normal alignment of the spine is restored.
Patient must have all the physical parameters stable prior to the surgery as this is a major surgery. Patients with concomitant diseases must comply with the prescription medicines, diet control to maintain the blood sugar level and blood pressure within the acceptable limits. Smoking and alcohol consumption must be stopped several days prior to the surgery.Excess mobility and physical activities must be avoided after the spinal fusion procedure in the initial few months following a spine fusion procedure. This is because the fused bone mass is getting firmer and established during this period and any stress can affect the fusing process. It is recommended to avoid certain movements completely such as lifting weight above 20 Kg, bending and twisting,. The expected time of this evolvement is approximate 2 years following the fusion procedure.
What is lumbar Fusion?
Lumbar Fusion is a surgical technique in which one or more of the vertebrae of the spine are united together (“fused”) so that motion no longer occurs between them.
When is Lumbar Fusion Recommended?
There are many potential reasons for a surgeon to consider fusing the vertebrae. These include: treatment of a fractured (broken) vertebra; correction of deformity (spinal curves or slippages); elimination of pain from painful motion; treatment of instability; and treatment of some cervical disc herniation.
How Long Will it Take to Recover from Lumbar Fusion Surgery?
Recovery following fusion surgery is generally longer than for other types of spinal surgery. Patients generally stay in the hospital for three or four days, but a longer stay after more extensive surgery is not uncommon. It also takes longer to return to a normal active lifestyle after spinal fusion than many other types of surgery. This is because you must wait until your surgeon sees evidence of bone healing.
Can I smoke after the surgery?
Nicotine is a poison for the body and special for the bones. It inhibits the fusion process of the bone and hence smoking is completely prohibited and not advised at all.
What is the role of physiotherapy after the surgery?
Physical activities help muscle develop strength and bring in coordination between the mind and the body parts. The physical exercise regime is introduced in the hospital soon after the surgery. Patients are advices to walk and to increase the walking period to bring in strength, and tone to the muscles. It is also a confidence building measure for the patients.
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