If You’ve Been Told You Need Spine Surgery Watch This First
Understanding Posterior Lumbar Instrumented Fusion: A Patient’s Guide
What This Surgery Really Means for Your Spine and Your Future
If you’ve been told you need a posterior lumbar instrument infusion, you might be wondering, “What does this mean for my spine, my mobility, and my future?” Before making any decisions, it’s crucial to understand exactly why this surgery is performed, what happens before and after the procedure, and how to ensure the best possible recovery. As a board-certified neurosurgeon, I’m here to walk you through the goals, benefits, risks, and expectations of this common spine surgery, giving you the knowledge you need to make an informed choice and prepare yourself for the journey.
[Music]What Is a Posterior Lumbar Instrumented Fusion?
A posterior lumbar instrumented fusion is a type of spine fusion surgery performed to stabilize and relieve pain in the lower back or lumbar spine. This procedure involves accessing your spine from the back, placing screws in the vertebrae and connecting them with rods. Sometimes we place bone graft or a cage between the two vertebrae to promote bone fusion. Over time, the vertebrae fuse together, reducing movement and alleviating pain. This surgery is commonly done for conditions like degenerative disc disease, spondylothesis, spinal stenosis, recurrent disc herniations, and stabilization of traumatic fractures. Let’s discuss these conditions in a little more detail.
Conditions That May Require This Surgery
Degenerative disc disease is a condition where the spinal discs, which act as cushions between the vertebrae, gradually wear down over time. This can lead to pain, stiffness, and reduce mobility as the discs lose their ability to absorb shock and provide flexibility. In some cases, the degeneration can result in herniated discs, spinal instability, or pressure on the nerves, causing symptoms like sciatica. The disc can also cause nearby inflammation resulting in pain. While disc degeneration is a natural part of aging, certain factors like genetics, repetitive stress, and lifestyle choices can accelerate this process. Removing the disc surgically, and fusing across that level may help treat some of the pain associated with that wear and tear.
Recurrent lumbar disc herniation occurs when a previously treated disc herniates again, often at the same site. This can happen due to factors like incomplete healing, continued degeneration, or excessive strain on the spine. If this continues to happen, the majority of the disc can be surgically removed and the vertebrae fuse to prevent ongoing problems at this level.
Spondyololisthesis occurs when one vertebrae slips forward over the one below it, potentially leading to some low back pain, stiffness, and nerve compression. This condition can result from aging related degeneration, stress fractures in the bones called the parsin articularis and congenital issues affecting spinal stability. In more severe cases, the nerves can become pinched resulting in leg pain, numbness, weakness or difficulty walking.
Spinal stenosis is a condition where the spinal canal or its tunnels narrow. Occasionally this stenosis can become so severe that it puts pressure on the nerves. A common cause is age related degeneration particularly from osteoarthritis of the joints but also from wear and tear on the discs. This can lead to symptoms like low back pain, numbness, tingling and weakness in the legs often worsening with prolonged standing or walking.
Traumatic fractures occur when a vertebrae breaks due to high impact injuries such as falls or car accidents. These fractures can lead to instability, severe pain, and potential nerve damage. In cases where the spine needs stabilization, a lumbar fusion surgery is performed to permanently join the affected vertebrae.
Goals and Benefits of Posterior Lumbar Fusion
The primary goals of a posterior lumbar instrumented fusion are to stabilize the spine, relieve nerve compression, and restore proper alignment. By using screws, rods, and bone grafts, surgeons can create a solid fusion between vertebrae, preventing excessive movement.
Benefits include:
- a stabilized spine
- relief of nerve and back pain
- enhanced ability to perform daily activities without discomfort
and this relief can be longlasting. While recovery does take some time, successful fusion can significantly improve a patients mobility and quality of life.
What Happens During Surgery?
Let me walk you through what happens during a posterior lumbar fusion in a way that’s easy to understand. Typically, you’ll be completely asleep under general anesthesia. The surgical area on your back is cleaned and prepped. The surgeon makes an incision in the middle of your back or just off to the side. Sometimes choosing to make two incisions, one on each side.
Muscles and tissues are carefully moved aside to expose the spine. If nerves are compressed, the surgeon may remove a portion of the bone covering the spinal canal and the tunnels where those nerves run. This creates more space for those nerves. Metal screws are then placed in the affected vertebrae and are connected with rods to stabilize that level of the spine.
Bone graft may be placed along the screws and rods connecting the vertebrae. Oftentimes, a significant portion of the disc is removed as well. This disc space is then filled with bone graft and a cage. This will encourage bone growth and lead to a fusion over time.
Once the surgeon has ensured that the nerves are unpinched and the hardware is in good position with nice alignment, the muscles and tissues are repositioned and the incision is closed in layers with sutures. The skin may be closed with sutures, glue, or staples.
Risks and Complications to Consider
Like with any surgery, a posterior lumbar fusion carries some risks, though they’re relatively uncommon when performed by an experienced and careful surgeon.
Risks include:
- nerve injury
- cerebral spinal fluid leak
- infection
- failed fusion
- adjacent segment disease
- decreased flexibility
- deep venus thrombosis
While these risks are relatively uncommon, proper pre-operative planning and attentive post-operative care significantly reduce complications. For more guidance, please watch my video covering how to prepare for surgery and minimize risk to ensure the best possible outcome.
Preparing for Surgery
Before surgery, your medical providers and surgical team will order and review pre-operative imaging, such as an MRI, CAT scan, and X-rays to confirm the need for surgery and to ensure that a posterior lumbar fusion is the right procedure for you.
You may require evaluation by your primary care provider to ensure that you’re at relatively minimal risk for undergoing general anesthesia. In many cases, if you smoke or use other nicotine products, you’ll need to stop before surgery. Nicotine not only affects wound healing, but it also affects bone healing, and it can result in a failed fusion. You may also require weight loss to ensure that you’re at a healthy weight for surgery. This is because obesity can substantially increase your risk of having a complication from spine surgery.
Recovery: What to Expect After a Posterior Lumbar Fusion
After surgery, most patients stay 1 to 3 days in the hospital for close monitoring. You’ll be encouraged to walk, and you’ll learn techniques for getting in and out of bed and participating in normal activities. You may be given a brace to wear for weeks to months after surgery.
You’ll be instructed on what activities to avoid, such as bending, lifting, or twisting. Strenuous exercises should be avoided early on, but many patients resume light activities soon after surgery. Your doctor may recommend physical therapy to help reduce excessive scar tissue formation around the nerves while also improving spinal muscle strength and restoring your mobility.
The fusion process can take 3 to 12 months for those bones to fully fuse together, but many patients start feeling better within days to weeks after surgery.
Is This Surgery Right for You?
So, is a posterior lumbar fusion right for you? Deciding on spine surgery is a big step, and posterior lumbar fusion is just one of the many options for treating low back issues. While it can be highly effective for stabilizing the spine and relieving nerve pressure, it’s not always the right choice for everyone. Your surgeon will guide you in making the best decision based on your symptoms, imaging, and goals of care.
If you want to learn more about spine surgeries, when to worry about back pain, how to choose a great surgeon, what to ask during a consultation, and how to prepare for surgery, please be sure to subscribe and share this video with anyone who might benefit. Thank you for watching, and I’ll see you next time.