Orthopaedic Procedures | Instrumented Lumbar Fusion

Introduction

 

For a variety of reasons one or more levels of the spine can degenerate causing back pain and sometimes instability. If pain can not be controlled by conservative treatments then a spinal fusion can be considered.

 

Nerves within the spine can also become irritated or compressed as part of the degenerative process. Nerve pain can occur and is usually felt along the path of the nerve which varies depending on which nerve root is effected. Nerve pain is often very difficult to control with pain killers.

 

Instrumented Lumbar Fusion

 

Operation

 

The spine is approached through a midline incision or two parallel incisions each side of the spine. The muscles are mobilized to expose the bone.

 

The bone is prepared to take a bone graft. Bone graft is harvested from the back of the hip area (part of the pelvis) and placed on the prepared spine.

 

To stabilize the spine across the fusion screws can be inserted into the bone and connected to rod forming a strong "internal splint". X-ray control is used to minimize the risk of incorrect placement of the screws. The metalwork supports the spine whilst the bone heals to form a solid fusion.

 

The wound is closed with absorbable sutures leaving a scar with no cross hatching and no need for suture removal. Sometimes a drain is used and will be removed 1-2 days post-op. Occasionally the suture ends do require trimming.


Post op

 

After the operation you will be encouraged to mobilize as soon as possible with the assistance of physiotherapists and nurses. Once mobile enough to manage at home you can be discharged.

 

You will be give instructions with regard ongoing mobilization and physiotherapy. An outpatient appointment will be arranged.


Outcomes

 

Many patients experience a significant reduction in their back pain following fusion . Some pain and discomfort will persist but hopefully it is more manageable than pre operatively. Sometimes despite apparently successful surgery no improvement is obtained.

 

In order to monitor the results of surgery you will be asked to complete outcome questionnaires from time to time.


Possible Complications

 

Most patients do not suffer any adverse problems. Occasionally complications do occur and can require further treatment.

 

Nerve damage is rare during surgery. If it occurs it can cause areas of numbness, pins and needles and weakness. Neuralgic pain can also be troublesome.

 

Cauda equina syndrome is very rare and occurs when the nerves to the bowel and bladder are affected. Any numbness around the bottom or problems with passing stool or water should be reported immediately.

 

Scar tissue can form around the nerve root tethering the nerve causing ongoing pain. Occasionally further surgery is required to free up the nerve.

 

Infections can occur in the wound and rarely deep around the fusion and metalwork. These can be treated usually with antibiotics but occasionally require surgical cleaning, debridement and removal of the metalwork.

 

Damage to the lining of the nerve root (Dura) can result in a leak of fluid (csf). This is usually noticed and repaired at the time of surgery. A short period of bed rest is advised after the operation. Rarely the leak persists and has to be repaired surgically.

 

Bleeding can be troublesome and is controlled at the time of surgery. Rarely bleeding continues post operatively and a second procedure is required to control it. Haematomas (collection of blood in tissues) may require surgical drainage.

 

Pseudarthrosis is the term used when the fusion does not take. If this occurs a further fusion operation may be required.

 

The bone graft donor site can be painful and take a long time to settle.

 

Metalwork failiure can occur and may need replacing or removing.

 

Adjacent levels of the spine take increase strain as a result of the fusion and can degenerate causing further problems in the future.

 

Anaesthetic complications will be explained by your anaesthetist.

 

Please be assured that every effort is made to avoid the complications listed and any others which can very rarely occur.


Questions

 

If you have any questions or wish to discuss things further please ask at any time. It is important that you have all the information you require and we will assist you in every way possible.

 

MR ANDREW HOWARD

Consultant Spinal and Orthopaedic Surgeon

Ref No ILR0205