A lumbar fusion is an operation to stabilise the spine with screws,rods +/- cages as well as decompressing nerves.

Why is a lumbar fusion recommended?

A lumbar fusion may be recommended by your surgeon is there if evidence of instability in your spine, if the operation needed to decompress a painful nerve may cause instability or if you are having a disc operation for back pain.

How is the surgery performed?

Lumbar fusion is perfomed by:

  1. Opening an incision in the back and removing bone/ligament disc to decompress a nerve
  2. Stabilising the spine by inserting pedicle screws into the bone and connecting them to rods
  3. Inserting an interbody cage in the disc space if required.
  4. Bone graft from the operative site and bone graft substitute is used in the cage(s) and around the screws to promote fusion.

There are four main types of lumbar fusion operation:

TLIF: a transforaminal lumbar interbody fusion. This is often performed via two  4-5cm incisions at the sides of your spine in and involves insertion of one cage across the disc space as well  as screws/rods.

PLIF: a posterior lumbar interbody fusion. This is perfomed by a mid-line incision in your back and involves insertion of 2 cages straight down the disc space.

XLIF: extreme lateral interbody fusion. This involves cage insertion via a small scar in your side, then insertion of screw and rods in your back which may be performed percutaneously. This approach is not an option for the lowest discs in the lumbar spine but can be a good option for L3/4 and sometimes L4/5.

ALIF: Anterior lumbar interbody fusion. This involves surgery through scar in your abdomen and the implants are inserted form an anterior approach. Due to rare problems with damage to blood vessels requiring a vascular surgeon on-call, this approach is not currently favoured in Manchester.

What happens after surgery?

After surgery there is likely to be some back discomfort but this can be well controlled with pain medication. Fgentle mobilisation is allowed onteh first post-operative day and with the support of our inin-hoouse physiotherapists most patients and mobile and confident to be discharged home on day 3 or 4.

Driving is not recommended for at least 2 weeks and you will be signed off work for 4-6 weeks depending on your individual circumstances. For manual  workers or spotspersons, a period of phased return will be required during the second period of six weeks. Running and golf do not commence until 3 months post-operatively.

How successful is the operation?

As for simple disc operations, success for nerve pain is excellent with 80-85% resolution of pain and 90% of patients satisfied or extremely satisfied with the outcome of surgery.

Improvement in back pain can be more variable. Literature report rates of improvement of only 50-70% in surgery done for back pain alone, although this data includes surgery done for patients in whom we would not recommend the operation at the Brain & Spine Clinic. The key to successful results for back pain after lumbar fusion rests with doing the right operation for the right patient. Your surgeon will talk you through this process.

What are the risks of surgery?

There is a small risk of wound infection (5%), bleeding (1%) or spinal fluid leak (5%).

Neurological injury to a spinal nerve or spinal cord is rare, but can result in serious problems such as numbness, weakness or paralysis in the limbs or problems with bladder, bowel or sexual dysfunction.

Rarely there may be an issue with an implant position despite insertion with x-ray control and this may need early revision surgery (1%).
In the longer term it is possible to have problems with fusion failure, implant loosening and adjacent segment disease, all of which may result in revision surgery.

There is a small risk associated with general anaesthesia (heart problems, chest complications, blood clots, infection) and these risks may increase with certain medical conditions.