Lumbar Fusion Surgery
What is a Lumbar Fusion Surgery?
Spinal fusion is a surgery to permanently connect two or more vertebrae in your spine, eliminating motion between them. The lumbar part of the fusion is noting the location that the surgery is taking place. Lumbar means the lower back part of your spine, and is the most common place for people to experience back pain. The goal of lumbar fusion is to eliminate pain, reduce or completely resolve symptoms and stabilize the spine to return the patient to normal daily activity.
How Spinal Fusion Works
Spinal fusion involves techniques designed to mimic the normal healing process of broken bones. During spinal fusion, your surgeon places bone or a bonelike material within the space between two spinal vertebrae. Metal plates, screws and rods may be used to hold the vertebrae together, so they can heal into one solid unit, and fuse as they heal.
Why is the Lumbar Fusion Operation Done?
Spinal fusion permanently connects two or more vertebrae in your spine to improve stability, correct a deformity or reduce pain. Your doctor may recommend spinal fusion to treat deformities of the spine.
Spinal fusion can help correct spinal deformities, such as a sideways curvature of the spine (scoliosis).
Spinal weakness or instability. Your spine may become unstable if there’s abnormal or excessive motion between two vertebrae. This is a common side effect of severe arthritis in the spine. Spinal fusion can be used to restore spinal stability in such cases. Herniated discs can also be treated by spinal fusion. Spinal fusion may be used to stabilize the spine after removal of a damaged (herniated) disk.
Candidates for Spinal Fusion
Candidacy for spinal fusion is considered for people who have conditions in which spinal fusion is a treatment option like scoliosis, instability, and herniated discs. If your pain is chronic, severe and is causing loss of function that diminishes your quality of life it’s likely you’d be a candidate for spinal fusion. If other types of treatment option haven’t worked this may also place spinal fusion as a surgical option. You may not be a candidate for spinal fusion if there is a severe illness or infection present.
Risks of Lumbar Fusion
Spinal fusion is generally a safe procedure. But as with any surgery, spinal fusion carries the potential risk of complications.
Potential complications include:
- Infection
- Poor wound healing
- Bleeding
- Blood clots
- Injury to blood vessels or nerves in and around the spine
- Pain at the site from which the bone graft is taken
Lower Back Surgery for Pain Relief
Lumbar fusion surgery can help relieve pain in the lower back and spine. However, spinal fusion is a major surgical procedure, so you should discuss all the details with your doctor before considering the surgery. There are nonsurgical options and non-invasive procedures that may be worth looking into such as laser spine surgery, an epidural injection or radiofrequency ablation. If lumbar fusion is a consideration, there is a noticeable reduction in pain after the surgery. People looking to get spinal fusion done usually have tried physical therapy and other nonsurgical measures, but still maintain the debilitating back pain.
How long does spinal fusion surgery take?
Spinal fusion surgery is unique to the patient being operated on since there are so many variables that go into any surgery. Your doctor will discuss how long the surgery will take for you beforehand. To get a general idea of how long the spinal fusion procedure may take it can be as little as 2 hours, or up to 6 hours depending on the number of vertebrae being fused. The level of degeneration of the vertebrae, and whether or not nerves are pinched also effect the length of surgery.
Fused Vertebrae in Your Spine
When fusing two vertebrae in your spine this will naturally take a while to heal. The bone graft is set between the two vertebrae and screws and rods may be used to keep the graft in place while it heals or “fuses” the two vertebrae together. Due to the nature of spinal fusion the range of motion in your back might be reduced, and bending during the healing process is advised against.
Are there permanent restrictions after spinal fusion?
Spinal vertebrae being fused sounds like it will be very restrictive to your range of motion, since the two vertebrae don’t move independently any more. So you might be asking yourself “What happens if I bend after spinal fusion?” The answer to that is it is recommended you avoid excessive bending after a lumbar fusion surgery. One bend likely won’t ruin a spinal fusion procedure, but you should avoid bending or putting any excess strain on your back for 3-6 months after the surgery so everything will heal properly. When you begin light exercise it’s best to do so under the guide of a physical therapist who specializes in spinal recovery. You can undertake more strenuous activities after 6 months of light exercise and healing.
Range of Motion after a Lumbar Fusion
The level of restriction you experience depends on the type of fusion you receive. Because in a lumbar fusion you are essentially losing the motion of a joint you may have a slight reduction in your range of motion. Though with single level spinal fusion this may not be noticeable. Even with multiple level spinal fusions you can still exercise and be active. With each extra level of fusion though, you will lose more range of motion, and bending forward and backward will be slightly different because of the loss of the flexibility of those joints.
Lumbar Fusion Recovery Timeline
Typically someone who has undergone a lumbar spinal fusion surgery can head home to the hospital after about 2 to 4 days as long as there are other people home who can ensure everything is fine. If you’re not on opioid medications you can start driving again 2-4 weeks after being sent home from the hospital. You can return to a typical office job after 4-6 weeks, but you should avoid any rigorous physical activity for 3 months or more. The length of time you’ll be able to return to normal activity is dependent on how many levels of fusion you have, meaning how many vertebrae are fused. As the bone graft facilitates bone growth between adjacent vertebrae it will take 3-6 months for the vertebrae to fully immobilize. The fusion will continue to solidify over 12 to 18 months after surgery.
Lumbar Fusion Physical Therapy Protocol
Physical therapy is an integral part of recovery after a spinal fusion. It’s important to work closely with a physical therapist so you don’t damage your spine or irritate your recovering muscular structure. You’ll want the personal guidance of a physical therapist who can monitor exactly when is the right time to perform different exercises. Here is a general outline of what a physical rehabilitation routine might look like after lumbar fusion surgery.
When 1 to 5 days has passed after the surgery you’ll want to learn the proper way to get in and out of bed, dress and perform other self-care activities. Walking is also important to do, with the assistance of a walker if needed for the first couple days. During this exercise phase you should aim for 1-2 miles a day walking with light TA and pelvic floor contractions. Your physical therapist can also teach simple neural mobilization. The first phase of recovery can last up to 6 weeks.
PT Guide after Spinal Fusion after 6 Weeks
The next phase lasts between 6 and 10 weeks, which involves resuming more normal activities under physical therapist supervision. Patients should slowly work up to 30 minutes of exercise and physical activity at least 5 days a week including a light weight-training program. Avoiding exercises that inappropriately load the lumbar spine is important, but lightly exercising muscles in the area with weights no greater than 10 lbs, and no overhead lifting is a typical routine at this phase.
The next phase is 11 to 19 weeks after the surgery, which sees a return to normal work and advancing the exercise program. More strenuous activities can be incorporated at this time, but you should still be cautious about overhead lifting as not to compress the spine in any way. After 20 weeks you should start progressing toward full restoration of your spine and have pretty much pre-injury levels of function. This phase can last up to a year after surgery depending on your health and commitment to physical therapy and fitness.
Results of a Spinal Fusion
Spinal fusion is an effective treatment for fractures, instability of the spine, and conditions like herniated discs. However, if the cause of back pain is not discovered and diagnosed it may not be effective to resolve the pain. It’s important to find the root of the problem first before exploring any surgical options by an Atlanta spine surgeon, and this will be your doctor’s first step in the treatment process. While spinal fusion is effective at treating spinal conditions and relieving symptoms, certain degenerative diseases of the spine like arthritis will need to be managed going forward after the surgery.