LUMBAR SPINAL FUSION

You have been diagnosed as having one of the back disorders requiring a spinal bone fusion and the recommended procedure is called a posterior lumbar fusion. This surgical procedure requires general anesthesia and a hospital stay of usually just 2 days. Time away from work will depend on the type of work that you do, but we normally advise 4-6 weeks. The goal of surgery is to have you return to an active lifestyle without significant pain. You have a 70 – 90% chance of accomplishing these goals after surgery. To increase your chances of a successful operation, you will be asked to do the following:

1. Begin a program of walking after surgery.   Walking will help you to heal your fusion in several ways. First, walking is an aerobic exercise; therefore, it will help to increase the oxygen level in your blood.   Increased oxygen means increased nutrition in the fusion, which will increase your success. In addition to adequate nutrition, bone needs a certain amount of stress to grow and become solid. Walking gives your body that stress. Your program of walking will consist of simply walking until you are tired or uncomfortable, and resting until you are ready to walk again. At your 3-week post op visit we hope you will be able to walk 1 – 2 miles per day.

2. Stop smoking, or at the very least, cut down. Smoking robs your blood of oxygen and delays healing which decreases your chance for a successful fusion. Patients who smoke after surgery have a 15 – 25% increase in the failure of the bone to fuse. We understand that it is often difficult to stop a long-term habit. The American cancer Society offers an excellent "STOP SMOKING" program, and they may be reached at 214-631-3862.

Dr. Gill will make an incision approximately 2 – 4 inches along your spine (not through your abdomen). Dr. Gill will choose an appropriate implant, which may be bone, plastic (PEEK) or titanium, to use as a spacer in place of your disc. Many times we also have to use pedicle screws, which are made out of titanium to keep the area stable while the bone is growing. Dr. Gill or his PA will outline to you exactly which method will be used for your particular need. The bone for the fusion comes from one of two sources. One source is you. Bone can be obtained from your spine or pelvic bone (which is rarely used) with no long-term effect on you. You will have discomfort from the donor site for pelvic bone graft after surgery, but this usually a short-term problem that will resolve with time. Bone can also be obtained from the bone bank (donor bone) or from a laboratory (synthetic bone matrix). Your own bone marrow cells will be mixed with the bone matrix.

The implant (internal fixation) and bone will be placed in between the vertebral bodies and/or to the side of the vertebral bodies between the pedicles. This is done to stabilize your vertebrae so the fusion can heal.   Internal fixation works by minimizing motion, much like a cast on a broken arm. Internal fixation consists of different combinations of metal rods, cages, or screws to stabilize the spine. Dr. Gill will decide the type you need. Depending on the type of internal fixation, it may need to be removed after your fusion is completely healed. Dr. Gill will decide if and when you need removal, which would require a minor surgical procedure.

When you are discharged from the hospital, you will have absorbable sutures under your skin holding the incision closed. On the top of the skin will be steri-strips covered by a clear plastic tegaderm. See the WOUND CARE information sheet.

You should avoid bending, twisting, lifting and carrying objects over 10 pounds for 4 – 6 weeks after surgery. Dr. Gill or his PA will them determine how you can progress your activity. Your main activity for rehab will consist of walking and resting when you go home from the hospital. You should start walking short distances 5 – 6 times a day, and then progress to longer distances fewer times a day.

You may have muscle spasms in your low back after surgery. This is due to having an incision. Walking and using ice on the muscle helps break the spasm. You may also notice different hip or leg sensations after the surgery. There can be some swelling inside the surgical site that can cause temporary pressure on the nerves. As your body heals, the swelling will decrease, and the sensations should resolve within 3-4 months. If the nerve symptoms are painful, there are medications that may be added to help relieve these symptoms. Please notify the office about painful symptoms.

If you smoke, are diabetic, or if you are 30 – 40 pounds over your ideal body weight, you may experience more difficulty after surgery with the healing process. If you are overweight, you may require surgical staples or external sutures that will be removed 3 – 6 weeks after the surgery. You will be seen in the office at 3 – 4 weeks post op. You will be given a list of your scheduled post op appointments

You will be provided with a white elastic abdominal binder that you will wear continuously (except in the shower or when it needs washing) until your first post op appointment, about 3 weeks after surgery. Dr. Gill will determine if you will need to wear a "hard brace" in addition to the abdominal binder. If so, you will be fitted for the "hard brace" in the hospital after surgery and will need to wear it when you are traveling in any moving vehicle or walking long distances. Most patients do not need the "hard brace".

An important point to understand is that pain is normal with a healing fusion. The pain can vary from minimal to severe. An increase in pain does not necessarily mean that something is wrong. You may experience some back pain and/or leg pain, which may be a dull or sharp pain that goes down the legs. Numbness or tingling my also be present after surgery.

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