Lumbar Spinal Fusion

1 What is a Back Surgery (Minimally Invasive Lumbar Spinal Fusion)?

Minimally invasive lumbar spinal fusion (back surgery) is an operation that causes the bones of the spine in the lower back to grow together (fuse) so there is no longer any motion between them.

By removing the intervertebral disc, bone spurs can be reduced some of the pressure on the nerves and pain reduced. Also, fusing two vertebrae together will stop the formation of bone spurs at that location, further reducing pain and potential nerve injury.

The lower portion of the spine found at the center of the curve of the low back is the lumbar spine and it can be a common source of pain. Low back pain is the second most common reason for visits to the family physician, behind only the common cold. Various changes occur in the lumbar spine and they can cause pain (in the most cases normal degenerative arthritis).

More than 90% of patients with low back pain will have improvement in their symptoms regardless of treatment within six weeks. The treatments include medications, physical therapy, or injections. Patients that do not improve during the first six weeks may be candidates for surgery.

There are many different specific techniques to try to fuse the vertebrae together and the surgery can be performed either through an incision in the back, the abdomen, or a combination of both. The decision on what type of fusion is best for each patient is based on their specific complaints and the cause of symptoms. Spinal fusion can be very effective in the properly selected patient.

Minimally invasive lumbar spinal fusion is similar to traditional lumbar spinal fusion, but it uses smaller incisions (approximately ½ inch) and causes less damage to the surrounding tissues during surgery. A fiber optic viewing camera is used, similar to other minimally invasive procedures including laparoscopic gallbladder or appendix removal.

Metal screws and rods are placed from the back through dilator tubes into the bones to hold them steady while the fusion occurs. The surgeon removes the intervertebral disc and places either a piece of bone or a metal or plastic cage in its place during an interbody fusion.

The most recent advance in minimally invasive lumbar spinal fusion is the ability to perform fusion surgery through the patient's side. There are several techniques that allow the surgeon to make a small incision (approximately 2 inches) in the patient's side, directly over the planned fusion site.

Specialized instruments can be used through the dilator tube to remove the intervertebral disc and place a bone graft or metal or plastic spacer in its place. This technique is typically combined with a procedure from the back to place rods and screws for additional support.

The major advantage of all of these minimally invasive techniques is that there is less damage caused to the surrounding tissues because in traditional spinal surgery, it is necessary to cut through muscles and move them out of the way in order to reach the spine and this can cause a large amount of pain following surgery, and it can lengthen the recovery time.

The minimally invasive techniques can gently spread through the muscles to allow access to the spine so this is much less painful for the patient, and it does not require as long of a recovery period for the muscle to heal.

Depending on the type of fusion, some patients go home the same day while others may go home in 2 to 4 days. Patient may need help with daily activities (e.g., dressing, bathing) for the first few weeks. Also, physical therapy may be recommended.