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 Lumbar
spinal fusion is a type of back surgery in which a bone graft is added in
front (disc space) and/or along the back (posterolateral gutter) of the
spine so that the bones in that segment of the spine and the graft fuse
together. It is designed to stop the motion at a painful vertebral segment,
which should decrease the pain caused by the joint. After the surgery it
will take several months (usually 3 to 6, but sometimes up to 18) before
the fusion is set up. This surgery has been improved over the last 10 to 15
years, allowing for better success rates, and shorter hospital stays and
recovery time.
Who should have this surgery?
The vast majority of people with low back pain will not need fusion surgery
and will be able to manage the pain and stay functional with non-surgical
care, such as physical therapy and conditioning. A spine fusion surgery
may, however, be recommended for patients with the following:
·
Back pain that limits the patient’s
ability to function caused by degenerative disc disease (after nonsurgical
treatments, such as physical therapy and medication, have failed)
·
Isthmic, degenerative or postlaminectomy
spondylolisthesis
- A weak or unstable spine
(caused by infections or tumors), fractures, or deformity (such as
scoliosis)
Because fusion is a major surgery, it is very important that all other
possible causes of a patient’s back pain be considered and ruled out
prior to undergoing fusion surgery. Generally fusion should not be
considered until the lower pack pain has persisted for more than six
months, and a concerted effort at conservative treatment has not relieved
the pain. Fusion surgery is generally only considered for one or maybe two
level problems. In general, multilevel fusions should be avoided.
Identifying the location of pain
If the patient is an appropriate candidate, and decides to have the
surgery, the next important step is identifying the exact location of the
excess movement that is causing the pain. The following methods are used
for this:
1. Review
of the patient history
The physician will review when the pain occurs, where it appears to be
located and how it began. He or she will also look at the previous
treatment, and the extent to which the pain limits the patient’s
activities. The physician will also decide if other factors (such as
depression) may be contributing to the pain.
2. Physical
exam
A physical exam is done to determine if there is any evidence of a
nerve-related injury. The physician will also consider how the
patient’s overall health (e.g. heart or lung disease) may influence
the role of the spine surgery.
3. Diagnostic
studies
An x-ray is usually done first to show if there is any instability or
deformity to the spine. This is followed with magnetic resonance imaging
(an MRI scan). MRI scans show very precise information about the health of
the discs and any degree of degeneration that has occurred. It is important
to note that degeneration is not uncommon, and may not be the source of the
pain. Other tests, including a CT scan with myelogram, a discogram,
electromyography, or a selective nerve root block may be ordered if the
physician feels they’ll be beneficial.
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