A spinal lumbar fusion operation is a surgical procedure that can provide support to a patient with back pain, a patient whose spine has instability, or a patient with abnormal curvature to the spine.
The procedure focuses on the lumbar region of the low back. When new bone grows together and becomes a single entity, the process is known as fusion. In the lumbar fusion, two or more vertebral bodies in the lumbar region of the spine are fused for stability.
In the process known as grafting, scaffolding materials are placed across the interbody space to immobilize the spine as the fusion takes place. Several different materials can aid in promoting bone growth to speed up fusion.
Bone extracted from another part of the patient’s body was the material of choice in the early days of this procedure. Within the past ten years, a plethora of other options have emerged, allowing the dependence on the patient’s bone to become less frequent.
For extra stability during the months required for complete bone fusion, the surgeon may take advantage of surgical implants in the spine.
Reasons for the Spinal Lumbar Fusion Surgery
When performed successfully, spinal lumbar fusion surgery can dramatically reduce the patient’s low back pain. Other reasons to have the surgery include immobilization of the spine at the level where the instability is occurring and restoration of more regular shape of the spine.
Treatment options for specific ailments, such as a compressed nerve due to thickening of the ligament and arthritis, can lead to the removal of a substantial quantity of bone. This can be the case, for example, in a lumbar laminectomy to relieve pressure on the nerve.
The removal of so much bone can cause spinal instability, and the surgeon may decide on lumbar fusion during the same surgical session to prevent the later need for lumbar fusion surgery.
Spinal Fusion Procedures: Description of Types
The surgery takes place when the patient is unconscious due to the administration of general anesthesia. The use of antibiotics at this time is also common for the prevention of infections.
After the medical team gently positions the patient in the correct position in the operating room, the surgery can proceed. With the guidance of an x-ray, the surgeon makes the surgical incision in the proper location.
The types of spinal fusion procedures are quite similar, but they differ in where the surgeon makes the surgical incision to approach the lumbar region of the spine that requires the fusion.
- PLIF and TLIF – The posterior lumbar interbody fusion, or PLIF, and transforaminal lumbar interbody fusion, or TLIF, take place when the patient is on his or her stomach, so that the surgeon may make the surgical cut along the midline of the back.
- In a PLIF, the surgeon places the grafting materials along both sides of the spine so that they can grow together and stimulate bone fusion. In a TLIF, the surgeon places the grafting materials diagonally across the spine. The PLIF and TLIF can both require supporting materials that go across the disc space. These stabilize the region during the healing process.
- DLIF and XLIF – The direct lateral interbody fusion, or DLIF, and extreme lateral interbody fusion, or XLIF, take place as the surgeon makes the surgical incision on the side of the patient to get to the spine. As in the PLIF and TLIF, the patient may require scaffolding materials across the disc space or interspace for extra support.
- ALIF – An anterior lumbar interbody fusion, or ALIF, occurs when the patient is on his or her back. Carefully avoiding the abdominal muscles, the surgeon makes a cut in the front of the body to get to the spine.
- AXIALIF – An axial lumbar interbody fusion, or AXIALIF, takes place as the surgeon works from the lower region of the spine. The surgical incision is behind the end of the lower spine, and the surgical instruments are under the sacrum and coccyx, thus allowing the surgeon to access the front of the spine.
- “360” fusion – A “360” fusion is a more extensive procedure in which fusion occurs at the front at the back of the spine. At the back, the fusion can take place between two facet joints, which are connectors between different levels of the spine, or between two transverse processes, which are bones that are directed toward the back of the spine. The front part of the fusion involves the union of vertebral bodies.
The surgeon can access the area through the back of the patient, through the front of the patient, or both. Another approach is to perform a “360” fusion by going from the side.
Lumbar fusion surgery is likely to require screws to be implanted into the spine to increase immobility and reduce the risk of poor fusion or non-union as the patient recovers from surgery.
Screws may be inserted into the pedicles of the vertebral bodies, or they may go through the facet joints. An open technique and a minimally invasive approach are two possible strategies for the placement of the screws.
Posterolateral fusion – In cases where more extensive immobilization support is warranted, the surgeon can add additional fusion materials by placing bone on the back and side of the spine. This should fuse as the rest of the patient’s lumbar fusion heals.
What Happens After Surgery
The patient is frequently permitted to return home in one to four days after the completion of the operation. To prevent jarring that could disrupt the fusion, the patient may need to wear a back brace at home.
Besides, bending, twisting, and lifting should not occur because they can interrupt the healing process. Until receiving clearance at an office visit a week to 10 days after surgery, patients should not allow the surgery wound to become wet or dirty.
They may suffer from back pain and back spasms, but these symptoms typically decrease within a week or two after surgery. Patients can go back to work when their physicians determine that they are sufficiently healed and that their job duties do not lead to health risks.
At SpineMD, what makes us stand out is our caring philosophy of being very conservative with our treatment approach; we reserve surgical treatment as a last resort and only consider surgery if all other nonoperative treatments have failed.
Please visit our spine doctor, Dr. Anil Kesani, the best spine Surgeon for a thorough systematic evaluation of your spine problem. Log onto our website www.myspinemd.com for more information.
More than eight out of 10 individuals will be understanding back pain sooner or later in their lives.
As a rule, the suffering leaves after some time.
On the off chance that your back pain is extreme or doesn't improve, you may require medical attention.
There are different reasons why your back can hurt, including muscle pain, disc pain, joint pain, or nerve pain.
You should look for medicinal consideration sooner if you have:Fever related to back painBack pain after an injuryLoss of bladder or inside capacityLoss of strengthUnexplained weight loss related to back pain Likewise, consistently be increasingly mindful on the off chance that you have unique hazard factors for malignant growth, contamination, or cracks that may influence the spine.If your back pain is from an ongoing strain or gentle damage, your essential consideration spine specialist can likely assist.
In any circumstance, if the pain is severe, continuous, or joined by different manifestations, for example, deadness or quivering in your arms or legs, it might be an ideal opportunity to see a back specialist.
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The new generation in this region is more concerned toward the benefits of cognitive training, which is not just limited to patients with cognitive dysfunctions.
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