Lumbar Fusion Surgery
Lumbar fusion (Arthrodesis) is a major surgery performed to permanently join together two or more bones in the spine so there is no movement between them. These bones are called vertebrae.
A lumbar fusion surgery is designed to stop the motion at a painful vertebral segment, which in turn should decrease pain generated from the joint. There are many approaches to lumbar spinal fusion surgery.
Indications of Surgery:
There are many potential reasons for a surgeon to consider fusing the vertebrae.
These include: treatment of a fractured (broken) vertebra; correction of deformity (spinal curves or slippages); elimination of pain from painful motion; treatment of instability; and treatment of some cervical disc herniation.
A decompression surgery relieves nerve pain by making more space around the spinal cord and nerve roots.
A second advantage of fusion is that it reduces post-decompressed deformity. Similarly, a fusion can correct any deformity the patient had before surgery and ensure that the normal alignment of the spine is restored.
Techniques of surgery:
- There are several different techniques used to fuse the spine. In the anterior technique the surgeon approaches the spine from the front. This requires an incision in the lower abdomen. For the posterior approach the incision is from the back. Sometimes, approach from the side is also attempted known as lateral approach.
- Minimally invasive techniques are developed to perform fusions with smaller incisions.The surgeon will decide and determine the approach based on the depend on the nature and location of the disease for each patient.
- All spinal fusions require bone material, called a bone graft, to aid the fusion. Generally, small pieces of bone are placed into the space between the vertebrae to be fused. this is known as bone grafting.
- A bone graft stimulates bone healing and increases bone production. This integrates the vertebrae to heal together into a solid bone mass. Solid pieces of large sizes are also used to provide immediate structural support to the vertebrae.
- The autologous graft from the patient’s own hip bone have been used for decades as the option for fusing the vertebrae.
- As this requires another incision from grafting of the bone this procedure lengthening the surgery time and increases pain and discomfort for the patients, this traditional method is no more popular.
- Allograft or cadaver graft are also available and are used if required. Artificial bone graft are known to safe, effective and are the most popularly used . Bone-forming proteins and minerals are also used as filler to promote solid bone mass depending on the condition of the patient, type, location and severity of the disease the surgeon will determine the type of surgical approach and the use of bone grafts and fillers.