Lumbar & Multilevel Spinal Fusion Surgery
A spinal fusion surgery is performed to stop motion at a painful vertebral segment. The purpose of this surgery is to reduce and alleviate discomfort generated from painful joints and degenerated discs by eliminating motion.
There are many different ways to perform a lumbar fusion, including anterior (through the abdomen), posterior (from behind) and lateral (through the side).
Each spinal fusion surgery technique is designed to add bone graft either from the patient (auto graft) or from synthetic bone fillers. Iliac bone marrow stem cells are often used as part of the grafting procedure. These grafts are added to the area to create a biological response similar to a fractured bone healing. The goal is to eliminate motion at the involved level and thus reduce pain in the process.
Spinal Diagnoses
Infection in the spine can occur spontaneously and presents a very serious problem. Bacteria can enter the blood stream when we scrape our elbow or brush our teeth. The body’s natural immune system usually eliminates the bacteria, however, this circulating bacteria can cause an infection in the discs where the blood supply is comparatively less. This is more common in people with immune suppression.
If the infection turns into an abscess, it can the spinal canal and become an urgent surgical issue.
Infection after spinal surgery is very rare. Prior to surgery, patients are instructed to wash their skin with a special soap. Prior to surgery they are give intravenous antibiotics, and often times antibiotic powder is placed in the incision.
Tumor
Scoliosis (curved spine)
How Spinal Fusion Surgery Works
Each level of the spine consists of the disc in front and two facets (joints) in the back. Think of each segment as a tripod. These structures work together to define a motion segment. When performing a fusion, for example L4 to L5, this is considered a one level fusion.
Most spinal fusions involve one or two levels. Fusion of spine bone is typical four months or longer. Fusion of leg or arm bones is usually two months. Fusion rates are generally greater than 90% for nonsmokers and healthy individuals; risk for poor outcomes increases with smoking, diabetes, obesity, and immune-comprised individuals (rheumatoid arthritis, steroid usage, renal failure).
A delayed union is when the spine bones take longer than six months to heal. The healing of the bones is monitored with xrays. Patients are often required to wear a back or neck brace for extra support during this process.
A bone stimulator is an electromagnetic device that is worn two to four hours per day to stimulate bone growth.
Multi-level Fusions
Scoliosis
Infection
Trauma with associated spinal fractures
Adjacent level deterioration
Posterior Lumbar Interbody Fusion (PLIF/TLIF) – Spinal fusion surgery is performed through the back and involves interspinous/interlaminar clamps or pedicle screws to stabilize the spine followed by cages (devices filled with bone) to stabilize the front of the spine.