Spinal surgery has been performed since 1938. Repair of spinal instability is done by grafting bone to fuse two or more vertebrae together. Spinal fusion surgery is performed on the upper (cervical), middle (thoracic) or lower (lumbar) vertebrae in the spine. In addition the actual incision made for the procedure can be from either the front (anterior) or back (posterior) of the patient. In this article we will be concentrating on Posterior Lumbar Fusion Surgery (PLFS).
(Fraser and Forer 10) Although the symptoms treatable by PLFS can be due to injury, some are due to biological defects or disease. The most common indicators are sciatic (traveling down the leg) pain, lower back pain, loss of leg control and in extreme cases, loss of bowel and bladder control. In most cases more conservative treatments such as physical therapy, spinal injections and micro surgery are tried before fusion surgery. The PLFS procedure is performed under general anesthesia and usually lasts 3-5 hours. Additional time may be needed for if many vertebrae are to be fused. The surgical team consists of an orthopedic surgeon, anesthesiologist, and their assistants.
In some cases a neurosurgeon may also be present. In most cases there are two incisions that are made: the location where the bone is to be removed from, and the area of the vertebrae (s) in the spine that are to be fused. In both incisions tissue and muscle will need to be moved aside to allow clear access to the bones. In some cases the bone is received from a bone donor bank and not removed from the patient.
This is usually done if factors such as weight, smoking or disease may impair the fusion process. (Steinmann 121) For patients who will have their own bone fragments removed, surgical tools similar to a hammer and chisel are used to remove them These fragments are taken from the pelvic area and are usually the size of match sticks or smaller. (Stevens) Before the fragments can be grafted together the vertebrae needs to be roughened up to accept the fragments. This is done with an instrument similar to a file or sandpaper. The fragments are then used to fuse the vertebrae (s) together. (Stevens) In most cases an electronic device called a bone stimulator is implanted.
This small device emits an electrical charge which stimulates bone growth. Once the new bone area is fused together (usually six months) this device is surgically removed. Because the unit is inserted just under the surface of the skin removal is performed as a outpatient surgical procedure. (Stevens) In cases of severe spinal instability additional devices may be used to strengthen the area of repair. Screws and wire cages are the most common examples. In extreme cases removal of a disc may also be required.
This is also known as a discectomy. (Steinmann 59) After the fusion procedure the respective muscles and tissues are moved back into place and the incision is closed with a layer of dissolving stitches inside and metal staples on the outside of the incisions. (Stevens) Most patients will require two to four days of hospital care. Eight to twelve weeks home rest is required from recovery from surgical trauma and for the bone to begin to fuse together. Four to six months after the surgery and when the area of repair becomes more solid physical therapy begins. This begins with basic stretching exercises and progresses toward increased physical actives such as biking and swimming.
Posterior Lumber Fusion Surgery is a tried and true procedure to relieve many of the extreme symptoms of back pain suffers. While it is a common treatment, it is only used after more conservative and far less invasive treatments have been tried. While future procedures are being researched to allow for smaller incision and less patient surgical trauma, PLFS is a very modern and effective treatment for extreme back pain problems. Fraser, Richard and Ann Forer. The Well Informed Patients Guide to Back Surgery. New York: Dell, 1992.
Stevens, Karen. Personal Interview. 4 Jan. 1999. Steinmann, Marion.
The American Medical Association Guide to Back Care. New York: Random House, 1984.