The lumbar area of the spine is better known as the lower back. A lumbar
fusion is an operation to stabilize the lower back by creating bony bridges
between at least two vertebrae and eliminating motion between them.
It can be done by fusing the vertebral bodies in front (anterior) or by
fusing the facet joints and lamina in the back (posterior). Bone or bone
substitutes can be placed on and between the lamina and the facet joints.
Metal screws and rods or plates may be attached to the bones to secure
the fixation while the bony bridge heals.
During the operation, a 4- to 5-inch incision is made in your lower back
and the muscles supporting the spine are divided. A small window is made
in the sheet of bone (lamina) covering the spinal cord.
Next, the surgeon removes any ruptured disc material or bone spurs that
are pinching the nerves or spinal cord. The site is then prepared for
fusion by obtaining bone graft and/or bone substitute and laying it on
the bone. Metal screws and rods or plates may be attached to the bones
to secure fixation while the bone heals.
The operation typically takes two to three hours; however it may be longer,
depending on the complexity of the problem and the number of vertebrae
needing to be fused.
Who is a candidate for lumbar fusion?
Lumbar fusion may be recommended to treat a number of spine problems. However,
the majority of people with these conditions will be successfully treated
with conservative measures – that is, without surgery. Only after
conservative measures have failed to relieve symptoms will surgery be
considered. Problems that may be treated with lumbar fusion include:
Sciatica – Sciatica is one of the most common reasons for lumbar fusion. It
is the irritation of a spinal nerve or nerves, usually by a herniated
or bulging disc.
Spondylolisthesis – This term describes a particular type of abnormal movement of the
vertebrae. With spondylolisthesis, one vertebra has slipped forward over
another. If the vertebra continues to slip back and forth, the spinal
nerves may be affected, causing leg pain, numbness, tingling and/or weakness.
Degenerative Disc Disease – Age and wear and tear can cause the discs that act as cushions
between each vertebra to shrink, allowing abnormal movement. This abnormal
movement can again result in an unstable area in the spine, and compress
the nerves, causing leg pain and numbness.
Arthritis – Arthritis of the spine can lead to spinal stenosis, a narrowing
of the spinal canal caused by bony spurs forming on the vertebrae, narrowing
the openings through which the nerves and nerve roots must travel. This
narrowing can cause pressure on the nerves, resulting in pain, numbness,
tingling or weakness down the legs.
Where does the bone for a fusion come from?
The bone graft can be taken from you or from a bone bank. If using your
own bone, the bone is removed from the back of your pelvis adjacent to
the spine; sometimes a second incision is needed, but often the donor
site can be reached from the spinal incision. Bone from a bone bank is
a good option if your own bone is weak or damaged from osteoporosis.
What are the risks?
While uncommon, complications can occur during and after surgery. Nerves
are exposed and nerve damage is therefore a risk. There is also a risk
that the bony bridge will not form and thus a fusion is not established.
Breakage or loosening of the screws or plates can also occur. These complications
could result in the need for another operation. Other complications that
may occur with any surgery include wound infection, blood loss requiring
transfusions, and blood clots. General medical issues such as pneumonia
or heart issues can be precipitated by surgery.
Your surgeon and health care team will be taking great care to help prevent
these and other complications.
How long is the hospital stay?
The time spent in the hospital after a lumbar fusion depends on several
factors, including your overall health and the extent of your particular
surgery. Many people will return home after one to three days in the hospital.
Recovery time after lumbar fusion depends on your particular situation,
the number of levels involved, your health and the technique utilized.
How long will it take to recover?
Recovery time after lumbar fusion varies depending on your particular situation,
the number of levels involved, as well as your general health. The key
to a successful recovery is maintaining a positive attitude. You will
be able to take short walks while in the hospital, and need to gradually
increase the distance and frequency of your walks once at home.
It can take up to three to four months for the bones to completely fuse
together. During this time you may need to wear a brace to protect the
operative area. Your doctor will give you specific instructions on activity
levels, including when you can resume driving and return to work.
To find a physician affiliated with the San Diego Spine & Joint Center
at Paradise Valley Hospital,
click here or call (844) PVH-CALL (844-784-2255) and a friendly representative will
Just give us a call. We'll be happy to answer any questions you may
have. And be sure to ask us about our upcoming seminars on back and neck
pain – we'd love to see you! For more information, call us 24/7
at (844) 784-2255, or you can
e-mail our spine and joint care coordinator.