Lumbar Fusion

Lumbar fusion is a procedure used to treat an array of spine-related conditions by permanently joining two or more vertebrae in the lumbar (lower-back) region of the spine. This surgery may be used to treat an injury, disc degeneration, or painful motion of the vertebrae, or to correct a deformity.

Baptist Health is nationally recognized for excellence in lumbar fusion procedures. We offer a full spectrum of orthopedic and neurosurgical care and the latest approaches to spine surgery. Best of all, you’ll appreciate convenient appointment times, locations near you and a personalized focus to meet your needs before, during and after your procedure.

What is a Lumbar Fusion?

Lumbar fusion involves placing bone graft material between two or more vertebrae (the interlocking bones that form the spine). Over time, the graft helps the vertebrae fuse together into a single, rigid bone, which can relieve lower-back pain and provide greater strength and stability.  There are a number of different graft types.

Autograft

Lumbar fusions commonly use an autograft, or graft from the patient’s own body. This material is less likely to be rejected by the patient’s immune system.

Allograft

This type of bone graft comes from a bone bank rather than the patient’s own body. This alternative lets the patient avoid the post-operative pain associated with the removal of bone material from their own body, but it also may provide less optimal healing compared to an autograft.  

Synthetic Graft

In some cases, synthetic materials may be used to support bone growth and help the vertebrae heal faster.

Additional Components

The procedure may also use additional instrumentation, such as metal plates, screws and rods. These are used to connect the vertebrae, correct a deformity or serve as an internal splint to hold the vertebrae together. 

What Can Lumbar Fusion Accomplish?

Lumbar fusion is used to improve stability, correct a deformity, or treat degeneration or injury in the lower back. This procedure may be used alone or in conjunction with another procedure for conditions related to the lumbar spine, including:

• Degenerative disc disease
• Spinal stenosis
• Broken vertebrae
• Fractures associated with nerve or spinal cord injury
• Infection
• Spine tumors
• Deformities
• Spinal stenosis
• Abnormal motion between vertebrae

What Can I Expect During the Procedure?

Spine fusion is a major surgery that can last for three hours or more while the patient is under general anesthesia. Your surgery team will begin by preparing a bone graft for the fusion. If the graft comes from your own body, it is typically removed from the pelvis through a small incision, which is then stitched up.

The spine fusion procedure can be performed in several ways:

• From the back, called a posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF)
• From the flank, called a lateral lumbar interbody fusion (LLIF)
• Through a corridor in the abdomen called an anterior lumbar interbody fusion (ALIF)

Using a PLIF approach, the surgeon makes an incision in the back. The fascia and muscle above the spine are held back with retractors to allow access to the vertebrae. It may be necessary to remove or trim down the lamina (the posterior arch of a vertebra) and other parts of this bone to reach the graft site.  

Using a TLIF approach, the surgeon makes an incision slightly to the left or right of the middle of the back, without having to move the nerves and back muscles. In either approach, the surgeon will remove the disc that serves as a cushion between the vertebrae, then insert the graft between the two vertebrae. Metal plates or other hardware may also be attached to keep the vertebrae in place during the healing process.

Using an LLIF approach, the surgeon makes a small incision in the flank below the ribs. This approach allows the surgeon to remove the disc between the vertebrae with minimal risk to the nerves. A graft is then inserted between the two vertebrae. Metal plates or other hardware may also be attached to keep the vertebrae in place during the healing process.

Using an ALIF approach, the surgeon makes an incision in the left lower abdomen to gain access to the front of the spine. The disc is then removed from the front with minimal risk to the nerves. A graft is then inserted between the two vertebrae. Metal plates or other hardware may also be attached to keep the vertebrae in place during the healing process.

In many cases, your surgeon may be able to perform any of these lumbar fusions through a minimally invasive procedure instead of traditional open surgery. This approach uses specialized instruments inserted through multiple smaller incisions to reduce the surgery’s impact on nearby tissue and promote a faster recovery time.

Recovery

The recovery period for spinal fusion is typically longer than for other forms of spine surgery. After surgery, you will stay under hospital care for three days or longer, and you will receive oral or intravenous pain medications to help you manage the pain around the incision.

Estimated Recovery Timeline

Once discharged from the hospital, you must greatly limit your activity, though bedrest at home is typically unnecessary. A back brace may help you feel more comfortable as you recover at home.

As your recovery progresses, your doctor will prescribe a physical therapy regimen. The type and extent of physical therapy depends on the specific procedure you had as well as your age, health and lifestyle. Your doctor may begin your rehabilitation program as early as a month after your procedure.

The time it takes the vertebrae to heal varies from patient to patient. Your doctor will monitor the results of the surgery during follow-up visits. Bone healing may start to become visible on X-rays as early as six weeks after surgery.

How soon you can return to work depends on how physically demanding your job is, the progress of your healing, and your age and overall health. Some patients may be able to go back to work as soon as four to six weeks after surgery.

Lumbar Fusion Possible Risks

Lumbar fusion is generally a safe procedure, but like all surgeries, it does have possible risks. These include:

• Infection
• Poor wound healing
• Bleeding
• Blood clots
• Blood vessel or nerve injury near the surgery site

Your doctor will provide instructions to help you prevent infection and damage to the wound.

It is important to understand that lumbar fusion will permanently affect how your spine functions. Because the fused vertebrae will no longer shift when you bend or straighten your back, other areas of the spine may experience greater stress. Your doctor and physical therapist can provide guidance to help you minimize stress on the spine and promote long-term healing.