What is Posterior Lumbar Fusion with Disc Removal?
Your doctor has recommended a type of back surgery, called posterior lumbar spine fusion, with disc removal.
This video will help you to understand the procedure.
Let’s begin by reviewing information about your body.
The spine, is a column of bones, that are stacked, from the base of the skull to the tail bone.
These bones, called vertebrae, are separated and cushioned by discs that make movement possible.
Besides supporting the weight of the body, the spine also forms a protective tunnel for the spinal cord, and other nerves that connect the brain to all parts of the body.
This protective space is called the spinal canal. It runs the length of the spine between the front and back of each vertebrae.
The lower back, known as the lumbar spine has 5 vertebrae. From top to bottom they are referred to as L1, L2, continuing down to L 5. S1 is the top of the sacrum, the strong base of the spine.
Most lumbar spine surgery involves the L4 , L5 and/or S1 vertebrae.
The spinal cord ends near the top of the lumbar spine. Below the spinal cord, are nerve bundles referred to as the cauda equina which is latin for horse’s tail, a description of how the nerve bundles look.
Spinal nerves leave the canal, fitting precisely through openings called foramen (say for-aye-men), that are between the vertebrae and discs.
Changes to the spine from age, or injury can pinch and squeeze nerves, causing pain, weakness, and disability. Let’s look at some examples of how this can happen.
- Vertebrae can move out of position, one bone shifting forward over the other.
- Discs can become damaged and rupture, putting pressure on spinal nerves.
- Bone changes related to arthritis, tumors, and breaks can cause vertebrae to press on nerves.
Lumbar spine surgery can be necessary to relieve pressure on spinal nerves, to lessen pain and improve function.
Posterior spine surgery can involve the lamina, the back walls of the vertebrae covering the spinal canal.
Sometimes only sections of lamina are removed. This is called a laminotomy.
When the whole lamina is taken, it is a laminectomy.
Both of these procedures take pressure off of the spinal canal.
A disc removal is called a discectomy. An implant called a cage is inserted in its place, between the two vertebrae.
The permanent cage is packed first with bone chips or other material to help the two vertebrae grow together and fuse, so they do not rub against each other.
Bones that have been cut during surgery can be stabilized with metal hardware including rods and screws.
Bone grafts, and other products may also be placed to encourage bone growth during healing, especially when two or more vertebrae must be fused together.
In general, back surgery may be recommended when daily life is limited by pain, especially when work, exercise and sleep are affected, and nonsurgical treatments are not helping.
Examples of nonsurgical treatments that may help some patients include weight loss, physical therapy, spinal injections, and medications.
Specific recommendations for surgical treatment depend on many factors, including a surgeon’s experience, the vertebrae and disc affected, the patient’s body structure, and overall health.
All methods need one or more skin incision. The incision size and placement varies with each procedure.
Be sure you understand which procedure is planned for you.
Now let’s look closer at an example of a posterior spinal fusion procedure.
Medication is given so the patient will be asleep and pain free during the procedure.
An incision is made next to, or near the specific vertebrae.
The surgeon works through layers of tissue to reach the spine.
Muscle and tendons are carefully shifted to the side and held in place to expose the vertebrae.
Lamina and other bone from the vertebrae is trimmed near the affected nerves. The entire lamina may be removed to uncover the spinal nerves.
The nerves are gently shifted to the side, and the damaged disc removed.
One or more permanent implants are inserted between the vertebrae.
The nerves are released to their normal position.
Bone graft material, rods and screws are placed as needed.
Muscle and tendons that cover the spine are put back into position, the skin is closed and a sterile dressing is placed.
After surgery, “speak up” and tell your care team if you have more than expected pain or problems.
They will be watching for early rare complications.
A posterior lumbar fusion, is generally followed by a hospital stay of 1 to 3 days.
During this time you will be assisted with early activity, to be out of bed soon after the procedure.
Safe movement can speed the healing process.
Learn about incision care, ask questions and pay attention to instructions.
You can expect to have some pain and discomfort.
Pain medication will help, but other approaches to make you feel comfortable will also be used.
You may find that anesthesia and narcotic pain medicine can cause side effects including itching, nausea and severe constipation.
Also, narcotic medications become less helpful with pain after the first few days.
To manage pain, you will find it best to use a combination of
- medication,
- exercises to relieve stiffness,
- rest,
- and ice. Use ice-packs wrapped in a towel. Never put ice directly on your skin.
By 6 to 8 weeks after surgery, incisions are typically healed, patients have less surgical pain, and better strength and mobility.
However, full recovery can take 12 to 18 months.
To help bone healing for a strong fusion,
- eat healthy foods, avoid junk food, sweets and soda.
- Move safely, which means no bending, twisting, or lifting.
- Don’t smoke, or use nicotine products,
- and be patient, this is a very slow process.
All major surgery has potential risks that include,
- unexpected injury to nearby structures,
- bleeding, sometimes requiring transfusion,
- and wound infection that can be serious.
Other rare complications include heart attack, stroke, pneumonia, and blood clot called a deep vein thrombosis or DVT.
Also, be aware of risks specific to lumbar fusion surgery that include,
- continued back pain, for about 20%, or 1 in 5 patients,
- failed fusion, meaning the bones do not heal for up to 10%, or 1 in 10 patients, and
- a spinal fluid leak causing headaches, that can occur during or after surgery.
Complications related to spinal nerve injury during surgery can include,
- new pain,
- leg numbness, and weakness,
- bladder control issues, especially incontinence,
- and very rarely sexual dysfunction, more commonly seen in men.
Hardware problems, such as broken or loose screws can happen months, even years after spinal fusion. This can be a rare complication. However high body weight, and multiple fusions increase this risk.
Your personal risk of complication relates to,
your overall health, the complexity of the surgery, and experience of your surgeon.
Call your doctor if you have trouble with diarrhea, vomiting or worsening constipation. Call if you have difficulty with urination, or leaking, a fever, headache, or pain that is getting worse even with rest and medication.
Call 911 if you have chest pain, severe shortness of breath, sudden dizziness especially if accompanied by fainting, weakness, or trouble speaking, bleeding that doesn’t stop and any other sign that you may be having a complication from the procedure.
Hospital admission, medication or surgery may be needed to correct some problems.
As you heal, communicate your concerns with your surgeon. If you do have long term side effects from your procedure, you will likely see improvement slowly over months as you continue to recover.
On the day of the procedure you should be ready to verify or confirm your list of medical problems and surgeries, all of your medications, including vitamins and supplements, any current smoking, alcohol and drug use, and all allergies, especially to medications, latex and tape.
All surgery and anesthesia have a small but possible risk of serious injury, even some problems very rarely leading to death.
It is your job to speak up and ask your surgeon if you still have questions about why this surgery is being recommended for you, the risks and alternatives.
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