What Is Lumbar Spinal Fusion?
Lumbar spinal fusion is the joining together of two or more vertebrae in the lower back, which is called the lumbar spine. Lumbar spinal fusion is usually performed in response to a herniated disc or spinal stenosis that is causing pain, tingling, numbness or weakness in the lower back or legs, as well as an additional concern for stability issues at the same area. Spinal fusion makes the spine more stable and eliminates the pressure on the nerves.
Common Reasons for Lumbar Spinal Fusion
Aside from stenosis and herniated or bulging discs, lumbar spinal fusion may be done for the following reasons:
- Broken vertebrae
- Scoliosis
- Spinal deformities
- Spinal instability, usually from arthritis[link TK] in the spine
- Spondylolisthesis, a condition where vertebrae slip out of place and put pressure on nerves
- Vertebral fractures
Candidates for Lumbar Spinal Fusion
Most back and leg pain will go away on its own, without surgery. More persistent pain often may be relieved with conservative treatment such as anti-inflammatories, rest, ice and physical therapy.
Patients who have lower back pain that radiates into the legs and who have tried more conservative methods of management without much success may be candidates for lumbar spinal fusion surgery. Lumbar spinal fusion works best if only two vertebrae must be fused—fusing three or more vertebrae is usually reserved for the most severe cases.
The Procedure
The goal of spinal fusion is for the vertebrae to grow together into one unit, which eliminates movement of the vertebrae, makes the spine more stable and prevents nerve compression. Lumbar spinal fusion surgery does not actually join the vertebrae together; rather, the surgery creates an environment that allows the vertebrae to grow together over a period of months.
The surgeon does this by placing a piece of bone or synthetic material called a bone graft between the vertebrae. The bone graft can come from the patient’s own body (an autograft) or from a cadaver (an allograft), or it can be created from ceramic or another synthetic material.
The body then uses the graft to grow new bone cells from one vertebra to the other. In addition to inserting the bone graft, the surgeon may use plates, screws or rods to hold the vertebrae together, which helps reduce movement as the bones fuse, or the surgeon may recommend a back brace for the same reason. It may take several months for the bones to fully fuse.
Recovery
Most people spend a few nights in the hospital. The pain after the surgery will be controlled with short-term and long-term measures such as medication and local anesthetics.
Over time, pain—both from the surgery and from the underlying condition that made surgery necessary—will improve, and activity levels can be stepped up. Physical therapy—focused on moving, sitting and walking correctly—will help, as will maintaining an active lifestyle.
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