Lumbar Fusion
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Key Takeaways
- Lumbar fusion is a surgical procedure that joins two or more adjacent vertebrae in the lower back.
- Lumbar fusion may help to address complications of the lower back, including arthritis.
- Depending on the nature of your lower back condition, a lumbar fusion can be performed through open surgery or minimally invasive techniques.
- Recovery outcomes of a lumbar fusion may depend on various factors, including your age and overall health, and may take from several weeks to a few months.
What is Lumbar Fusion?
Lumbar fusion is a surgical procedure that joins two vertebrae in your lower back (the lumbar spine). The treatment is typically recommended to treat significant lower back complications that cause pain, discomfort, and other concerns. The procedure involves permanently linking the two vertebrae in place, allowing them to heal as a single bone to prevent movement that might cause pain. As such, it may help to treat lumbar spine complications while maintaining your spine’s stability.
The lumbar spine consists of five vertebrae that are much thicker than other spinal vertebrae. Their thickness is a vital part of their function, as the lumbar vertebrae support most, if not all, of your body weight. It is also your body’s centre of balance and is responsible for stabilising your back and spinal column, while various muscles, ligaments, and other structures are also attached to it to allow body movement in nearly every direction.
Why is Lumbar Fusion Performed?
Any injured or impaired lumbar vertebrae can cause complications that may affect your mobility and stability. Other possible symptoms may also arise, including pain, discomfort, and stiffness. In some cases, you may experience leg pain due to bone fragments or diseased tissue that is pressing on nearby spinal nerves.
A lumbar fusion typically involves the use of bone grafts placed along or in between your vertebrae, depending on the condition. The graft may be sourced from your body (autograft) or obtained from a deceased donor via a bone bank or hospital (allograft). Synthetic grafts have also been used in some cases or when combined with other natural grafts.
The main purpose of the lumbar fusion procedure is to surgically implant the bone grafts into position and ensure they are anchored in place to begin the fusion process. With the graft in place, it stabilises that particular lumbar segment and prevents it from moving to address the root cause of your symptoms. Over time, the vertebrae will gradually heal together and form a single, solid bone.
A lumbar fusion is typically performed to treat the following conditions.
Arthritis
Arthritis causes joint inflammation that may also affect the joints between lumbar vertebrae. Lumbar fusion may help manage this complication to restore mobility and stability while treating your pain and discomfort.
Spondylolisthesis
This condition occurs when one of the lumbar vertebrae slips out of place due to gradual wear and tear or an injury to the vertebra. Lumbar fusion involves permanently fusing the slipped vertebrae with a neighbouring vertebra to hold them in place.
Vertebra Fracture
A fracture to any lumbar vertebra could weaken the bone and cause complications if left untreated. Lumbar fusion may prevent a fracture by fusing the fractured vertebra to a neighbouring vertebra, preventing further bone weakening.
Scoliosis
Scoliosis causes an abnormal curvature of the spine that impacts your posture, leading to pain or breathing difficulties. Lumbar fusion may help by permanently straightening the lumbar spine and holding it in place.
If necessary, your surgeon may also perform other surgical procedures in tandem with a lumbar fusion. For example, if you have a herniated or damaged intervertebral disc, a discectomy can partially or fully remove the disc before proceeding with the spinal fusion.
Essential Considerations for Lumbar Fusion
Before undergoing a lumbar fusion, your spine doctor will inform you of what you can expect before, during, and after the procedure.
Recovery Outcomes for Lumbar Fusion
A lumbar fusion can be performed as an open surgery or with minimally invasive methods, depending on the condition of your lumbar spine. An open surgery allows your surgeon to have a clear view of the surgical area and perform the lumbar fusion process. This procedure may be recommended for more complex lumbar spine conditions. However, it typically has a longer recovery time due to the size of the surgical incision needed to access the lumbar spine.
In contrast, minimally invasive procedures use smaller incisions and specialised instruments to view the lumbar spine and perform lumbar fusion. Most minimally invasive procedures tend to have shorter recovery times since they cause less damage to surrounding tissues, muscles, and other structures.
A successful lumbar fusion will require some monitoring, but if your doctor believes that your recovery is progressing well, you may be discharged early. You may need to use crutches to help you move around while you are recovering. Your doctor will also schedule follow-up appointments to monitor your progress. These follow-ups can involve a review of your recovery plan, where needed.
Risk Factors for Lumbar Fusion
Lumbar fusion does have potential risks, and your doctor will inform you of these so you can make an informed decision about the surgery. Take the time to understand these risks and ask questions to clarify any concerns or doubts you may have. Some risk factors include, but are not limited to:
- Blood clots, such as deep vein thrombosis
- Bleeding
- Risk of infection
- Pain at or around the bone graft site
- Persistent pain or discomfort
- Recurring symptoms affecting the lumbar spine
- Additional symptoms that may require additional treatment
People who smoke or have diabetes may also be at risk of a condition called pseudarthrosis. This condition occurs when there is insufficient bone formation to form a solid fusion and support the graft.
Preparing for Lumbar Fusion
The initial consultation enables your doctor to thoroughly review your medical history, asking questions to gain an understanding of your condition and prepare an initial diagnosis. They will also perform various diagnostic tests to confirm the diagnosis and ensure that you are eligible for lumbar fusion. Your doctor will explain the process and guide you to prepare for surgery. You can ask them questions about the procedure and understand what to expect.
Before Lumbar Fusion
Your doctor will outline what you can expect from the lumbar fusion procedure and help you to prepare for it. Take note of the following before your surgery.
- Current health: Certain medical conditions may increase the risk of complications after surgery. A comprehensive health screening helps your doctor plan your surgery. If you are currently on any medications, especially blood thinners, you may need to switch to other alternatives or stop taking them temporarily.
- Illness: If you are feeling unwell on the day of your surgery, notify your doctor. Your doctor may postpone your surgery if you are not feeling well to minimise the risk of harmful side effects.
- Fasting: You may need to avoid eating or drinking for 6 hours before surgery, though sips of water may be allowed to help you stay hydrated during this period.
- Health evaluations: If you have any dental or urinary procedures scheduled before your surgery, rescheduling them may help reduce the risk of infection.
- Post-surgery support: After your discharge, you should have a family member or close friend around to help with daily activities or accompany you when going out.
- Lifestyle changes: Avoiding smoking, reducing alcohol intake, engaging in regular physical activity, and attending follow-up appointments are essential to ensuring your recovery proceeds smoothly.
On the day of surgery, a final medical check and a review of your anaesthesia needs are typically conducted. After this, you will change into a surgical gown and wait for the procedure to begin.
During Lumbar Fusion
You will first be sedated or placed under general anaesthesia before surgery begins. The procedure may differ depending on whether your surgeon opts to perform an open surgery or a minimally invasive one.
Open Surgery
In an open surgery, the surgeon will make a large incision close to your lower back, then carefully move other muscles, tissues, or structures aside to access the lumbar spine. In some cases, if decompression surgery is needed due to bone pressing on your spinal nerves, your surgeon may suggest using the bone fragments harvested from this procedure as the graft. Otherwise, a pre-selected allograft or an autograft is used instead.
The surgeon will carefully position the bone graft and secure it with screws and rods to stabilise the vertebrae to facilitate the fusion (internal fixation). They will then re-examine your lumbar spine to ensure the surgery proceeded smoothly before closing the incisions with stitches. The medical team will then transfer you to the recovery room for observation before returning to the ward.
Minimally Invasive Surgery
With this procedure, small incisions are made to allow the surgeon to reach the lumbar spine. An arthroscope equipped with a camera and light, paired with specialised surgical instruments, is inserted to provide a clear view of the lumbar spine and surrounding structures, as well as perform the necessary surgical procedures. If necessary, they may need to move nearby tissues, muscles, and other structures out of the way to access the affected vertebrae.
Using these surgical tools, the surgeon will carefully place the bone graft in position before attaching plates, screws, or rods to secure the vertebrae together to facilitate the fusion. After a thorough check to ensure the procedure went smoothly, the surgeon will carefully close the incisions with stitches. You will then be transferred to a recovery room for observation before you can return to the ward.
After Lumbar Fusion
Depending on your recovery post-surgery, you may need to be monitored for a few days to ensure there are no complications, or you may be allowed an early discharge. They will also share helpful tips to support your recovery at home, including how to care for your lower back and maintain proper posture to avoid placing too much strain on it.
Caring for your surgical wound, keeping it clean, and being mindful of your movements may also contribute to your recovery. You may be prescribed pain medications if you experience any discomfort after surgery, as well as care tips to facilitate your recovery.
- Start with light activity as recommended by your doctor. As you slowly regain your strength, you can gradually increase your activity level.
- Avoid strenuous physical activities, including lifting heavy objects, that could put pressure on your lower back.
- Keep your lower back properly positioned whenever you move to minimise complications. Avoid overexerting yourself to reduce the risk of injury to the fused bone.
- Attend physical therapy sessions to support your recovery. Targeted exercises will help to strengthen your lower back and gradually improve its range of motion and flexibility. Your physiotherapist will recommend various exercises to help you heal.
- If your doctor provides prescriptions for your recovery, take them at the specified times and according to the recommended dosage. If you experience any sudden side effects, stop taking the medications and notify your doctor immediately.
- If you need to wear a back brace, ensure that you wear it as instructed by your doctor. In most cases, you will need to wear it for several weeks after your lumbar fusion surgery.
- Have someone who can support you when you need to move around or perform activities of daily living.
- Practice healthy lifestyle habits, such as weight management and eating healthy, well-balanced diets, to reduce the pressure or strain on your lower back.
The new bone may take several months to grow and stabilise the lumbar spine, so your overall recovery time will depend on your age, general health, and other factors.
Frequently Asked Questions
It is common to experience some pain as a result of the surgical procedure, but this will slowly disappear after some time. If you are still feeling persistent or recurrent pain even after several weeks or months have passed, contact your doctor immediately.
It will typically take some time for your lumbar spine to heal sufficiently, which may take around six weeks to three months before you can start physical therapy.
A lumbar fusion may help relieve symptoms affecting your lower back and restore your quality of life throughout the recovery process. Recovery takes time, so you will need to be patient and adhere to your doctor’s care instructions. However, due to the nature of the fusion process, it may be likely that you could lose some flexibility in your lumbar spine.
Our Orthopaedic Doctor and Surgeon for Lumbar Fusion
Dr. Razmi
FAMS (Ortho) | M Med (Gen Surg) (SG) | FRCSEd (Gen Surg) | MBBS (SG)
Dr. Razmi, a practicing orthopaedic and spine consultant at Mount Elizabeth Novena Hospital.
Dr Razmi routinely performs discectomy (minimally invasive surgery), decompression surgery, spinal fusion, motion preservation surgery including dynamic stabilization and dynamic fusion technologies and lumbar and cervical disc replacements. He is the first surgeon in Singapore to perform stand-alone anterior approached spine fusion using the Synfix implant.
Related Treatments
A slipped disc, also known as a herniated disc, happens when the soft inner core of a disc, called the nucleus pulposus, pushes through the tough outer layer, called the annulus fibrosus.
A lumbar discectomy is a surgical procedure that removes part or all of an intervertebral disc in the lower back (lumbar spine). It is commonly performed to treat herniated discs, where the soft centre of the disc (nucleus) pushes through the outer ring (annulus).
