IntroductionA 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 ProcedureThis 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.
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.
RisksSome of the risks and complications associated with this procedure include:
- Wound infection
- 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
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