Posterior Lumbar Fusion

Surgical Procedures

When conservative measures fail, or when there is a danger of nerve or Spinal cord damage, surgery is the next option. On this page you will see the surgeries that we perform. Though most of our procedures are “outpatient” not every patient is the same. Some people have other diagnosis that will slow down recovery from either the surgery itself or anesthesia. These people will possibly be admitted to the hospital for their own safety and comfort.

Introduction

A Posterior Lumbar Fusion is performed to stabilize the lower spine and to eliminate painful movement that may be caused by one or more segments.

This procedure commonly is used to treat lumbar spondylolisthesis, lumbar degenerative disc disease and recurrent lumbar disc herniations.

This procedure can be performed utilizing a minimally invasive approach to minimize soft tissue disruption and blood loss. An implant is placed in the disc space to restore and maintain normal height while removing pressure off of the nerve roots.

This procedure can be performed as an outpatient procedure for a select group of patients who require a one level fusion. Patients who require more than a one level fusion and/or those with other medical concerns likely would benefit from an overnight stay in the hospital after this procedure

As with any surgical procedure, there are potential risks and benefits that should be discussed and considered.

Description of Procedure

This surgery is performed under general anesthesia. Once you are comfortable and asleep, you will be positioned on your stomach. Live x-ray is used to localize the area of your incision.

Depending on the specific approach used, either a single incision will be made along the midline of the low back or two small incisions on either side of the spine can be used. Actual length of the incision will vary based on the number of areas to be decompressed. Layers of muscle and soft tissue are separated carefully to reach down to disc space from one side. A small retractor is placed to protect the nerve roots. A cage that is filled with bone graft is placed into the disc space to restore and maintain the nature height. Pedicle screws are then placed into the vertebra to create a rigid construct. Additional bone graft is placed along the sides. Fluoroscopic (live x-ray) images are obtained to confirm the placement of the implants.

Layers of muscle and soft tissue are sewn back together using suture. The skin may be closed with small skin staples.

FAQ's




Depending on the number of levels requiring surgery, this procedure can be performed as an outpatient for a one level fusion in properly selected patients. Those who require more than a one level fusion and those with other medical concerns generally require an overnight stay in the hospital.


Some patients will be prescribed a brace following surgery. This may be worn up to 3 months. The surgeon often determines the need for the brace based on the patient’s bone quality, activity levels, and complexity of the surgery.


While everyone’s pain tolerances and conditions differ, most find that back pain begins to lessen over the first 4 to 6 weeks after surgery. Your activities will be restricted during this time period. Those who have more than one level fused may take longer to recover


This depends on the type of work you perform and the duties involved. Dr. Shim will discuss this with you during your first post-operative follow-up visit. In general, most patients can return to a sit down type job with no lifting required within 4 to 6 weeks after surgery. Those patients who have heavier duty occupations requiring lifting, pushing, pulling, and overhead activity can expect to be out for longer perriods


Most patients can return to driving 2 – 3 weeks after surgery. If you are taking narcotic pain medication, you should not drive a motor vehicle.


Your incision may be closed with staples. A Silverlon will be placed over the staples. This dressing should remain on until the time of your first post-operative visit with Dr. Shim. If it begins to fall off, please contact the office


As a normal part of the post-operative period, we encourage you to get up and walk shortly after your surgery. You may walk as much as you can tolerate.


Most patients do not require physical therapy after this type of procedure. Dr. Shim will provide you with some basic exercises to begin following your first post-operative visit. For those patients who had significant weakness before surgery or are having persistent back stiffness after surgery, therapy may be recommended.


Staples will be removed approximately 12-14 days after surgery


Yes, you may resume sexual activities as soon as you feel up to it. This may be a few days or even a few weeks after you come home from the hospital. You should avoid positions which cause increased back discomfort.


Most patients are free to travel after their initial post-operative visit 12 –14 days after surgery. Patients who may have been experiencing any problems during this time may be encouraged to wait a little longer before traveling. Keep in mind, you will not be able to carry any luggage greater than approximately 10 –15 pounds for the first 4 weeks after surgery.


You will need to avoid taking a bath or submerging in water for approximately 3 weeks after surgery.


One of the benefits of the Silverlon dressing is that you may get it wet. You may begin showering the second day after your surgery. We recommend that you turn your front side to the showerhead so that your dressing does not get saturated.


A stool softener will be ordered for you while in the hospital. You may discontinue this after your first bowel movement or at your discretion.


Most patients will be able to walk upstairs after surgery. You should limit the amount of times you go up and down the stairs during your first few days home. We encourage you to use a handrail if one is available.


You will be able to get in a pool and walk approximately 3 weeks after surgery (or when incision is fully healed).


Everyone’s pain tolerances and conditions do vary. In general, many patients experience some relief of their leg symptoms immediately after surgery. It is not uncommon to have back pain, soreness, stiffness, spasms and incisional discomfort for several weeks beyond surgery. For some patients, the pain level may decline slowly over weeks or even months after surgery.


Several reasons for this. First, you were given medications to help relax you and your pain during the surgery along with the anesthesia. This combination of medications may stay in your system for a day or two after surgery. Secondly, as you start feeling better, most patients become a bit more active, this can lead to increased discomfort initially.


A sore throat can result from anesthesia in some cases. You received an endo-tracheal intubation (“tube”) into your throat to help you breath during the procedure. This may have irritated the lining of your throat. This soreness and even some difficulty swallowing tends to resolve within a few weeks after surgery.


If you experience any fevers over 101.5 degrees, any wound drainage, swelling or redness around your surgical incision, increasing pain, tingling or numbness that you did not have before surgery, difficulty swallowing, difficulty walking, severe headaches, difficulty urinating or weakness, call your doctor.


You can lift up to 5 lbs. after surgery until your first post-operative visit. Heavy lifting should be avoided for a minimum of 3 to 4 months after surgery. On a long-term basis, you should avoid heavy lifting as this may contribute to further problems with your spine.

Risks

Some of the risks and complications associated with this procedure include:

  • Wound infection

  • Hematoma

  • Bleeding

  • Nerve injury

  • Cerebrospinal Fluid Leak from a Dural tear

  • Loss of bowel or bladder function

  • Blood clots

  • Numbness (temporary or permanent)

  • Scarring of the nerve(s)

  • Hardware failure or dislodgement

  • Adjacent segment disease

  • Incomplete relief of symptoms

  • Risks associated with anesthesia

Disclosure Statement

The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.

This website is certified by Health On the Net Foundation. Click to verify. This site complies with the HONcode standard for trustworthy health information:
verify here.

Author and Contributor to www.Spine-Health.com – July, 2015

www.Spine-Health.com/author/john-h-shim-md-facs

Chief of Surgery, Mease Countryside and Mease Dunedin Hospitals, Safety Harbor and Dunedin, Florida. 2014-2016.

Orthopaedic Section Chief Mease Countryside Hospital; Safety Harbor, Florida Mease Dunedin Hospital; Dunedin, Florida.2008-2013

Board Member Morton Plant Mease Research Council

Co-Director of Mease Neuro-Ortho Spine Center Mease Dunedin Hospital; Dunedin, Florida.

One of “6 Spine Physicians Ranked #1 on Google” – December 2016

Top Ten Most Liked Spine Surgeons on the Internet – July 2016

2016 Spine Surgeons to Know list – January 2016

2014 Spine Specialists to know list – September 2014

One of Ten Leaders of Certified Spine Programs – December 2011

 

The Best Orthopedics in Tampa

The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.
Outpatient Spine Surgery Considerations. www.Spine-Health.com. January 2016.

What is Spinal Stenosis? www.Spine-Health.com. October 2015.

Surgeon insights on the Changing Landscape of Orthopedic Care. OrthopedicToday. June 2014

Chapter 33: Interspinous Spacers. Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

Chapter 35: Minimally Invasive Percutaneous Lumbar Fusion Technique.Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

March 2010 Minimally Invasive Transforaminal Lumbar Interbody Fusion American Academy of Orthopaedic Surgeons Annual Meeting New Orleans, Louisiana February 2010

February 2010 A Review of Dynamic Stabilization in the Lumbar Spine Selby Spine Symposium; Park City, Utah

November 2009 Lumbar Spinal Stenosis Community Based Lecture; Tampa, Florida

September 2009 Instructor/Proctor Minimally Invasive Lumbar Cadaver Lab; Tampa, Florida

February 2009 New Spinal Technology: Cervical Disc Replacement and Interspinous Spacers. Selby Spine Symposium; Park City, Utah

February 2008 The Degenerative Spine: The Role of Dynamic Lumbar Stablization and Interspinous Spacers Selby Spine Symposium; Park City, Utah

October 2008 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

September 2007 Emerging Technology in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

October 2006 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

May 2005 The Role of Kyphoplasty in the Treatment of Vertebral Compression Fractures Mease Neurosciences Symposium; Clearwater, Florida
Please note all articles, blogs and Q&A’s on this site are general information and are not to be used as medical advice for individuals. No specific diagnosis or treatment should be made based on this information. Only a physician can provide you with advice specific to your situation. Please followup with your physician if you would like to discuss your individual condition.

If you are having a medical emergency,  contact your Doctor immediately,  or go to the Emergency Room.
ShimSpine and ShimSpine.com is committed to honoring and respecting the privacy and anonymity of the individuals using its website(s) and/or services. The purpose of this Privacy Policy is to inform the individuals about the collection, processing and protection of information done by ShimSpine what information we collect, why we collect this information and how we use this information.

This Privacy Policy will be reviewed regularly to reflect the up-to-date practices of ShimSpine.