Lumbar Fusion FAQ’s

Spondylolisthesis or slipping of one vertebra over the other are usually taken care by the surgery if it fails to give relief with conservative means. It is not necessary to get them 100% reduced, but the most important part is to relieve the neural elements of all the pressure, which is caused either by the bony vertebrate or the disc and prepare the vertebrae for fusion. In case of lumbar spine, spondylolisthesis need not to be reduced fully 100%, especially if the patient has a high grade listhesis, it is not desirable to reduce it completely. An important part of surgery is to clean the pressure of the spinal and nerve roots and prepare a healthy environment for bones to fuse.

Patients are not required to start their physical therapy till two weeks after the surgery. After two weeks of surgery, physician reexamination will help in deciding if the patient requires physical therapy or not. Many of the patients do not require physical therapy after the surgery.

Smoking has proven to cause spine problems, including neck and lower back. At the same time, smoking is detrimental for patients who require spine surgery, especially fusion surgeries. It has been shown that smoking delays spine fusion, as well as lead to higher incidence of nonunion and possible need for revision surgeries.

For patients undergoing fusion surgery, it is highly desirable that they quit smoking. Smoking is detrimental for bone healing and hence the fusion. Smokers are at a higher risk of nonunion, that means non healing of the fusion mass, and these patients may need revision surgery. If the patient is not able to quit smoking, it is at least highly desirable for them to quit for three months. Use of the nicotine patch in place of smoking has the same detrimental effect as smoking itself.

Usually, before the surgery, we discuss with the patient regarding all the possible spine issues that we may expect and how to manage them. If there is an unexpected issue, which has not been discussed earlier, we would go ahead and discuss it with the patient’s relative and treat it accordingly from there. If there is something which can wait, and is not detrimental to the patient, and relatives are not able to make decision on it, we may leave it for a later date to be discussed with the patient after the surgery.

Most of the patients with back surgery can be discharged within one to four days after the surgery depending on the type of surgery and the type of recovery that they have. Patients who undergo complex spine surgeries may need longer period of hospitalization and recovery.

Most of the patients with cervical spine surgery, will be sent with some narcotic pain medication to take care of their pain. These medications do have their multiple side-effects, which may be constipation, nausea, vomiting, impaired judgement, drowsiness, headache. Though patients who are treated with narcotic pain medication for acute pain, mostly do not lead to addiction, but these medications do have addiction potential.

Most of the patients with spine surgery do not need a brace. If we expect that the patient will need a brace, we will get the patient pre-fitted with a brace so that it is available immediately after the surgery. Occasionally the need for brace may be decided at the time of surgery. In such cases a brace is arranged in immediate post-operative period.

Patient may need other medical equipment like walker or a stick. If that is required, patients are provided with such equipment in the hospital before their discharge and are trained how to use them by the physical therapist and occupational therapist. If the patient needs to use stairs, patients are trained by the physical therapist before they are let go home. If the patient needs an adjustable bed, they are informed about that. That can be done prior to the surgery. It is desirable for patients to stay downstairs for a few weeks if possible.

In case patient has routine questions regarding after the surgery or regarding the surgery, they can call the physician’s office and talk to the nurse or secretary or the physician. If they’re not available on the phone, they can leave a voice mail and they will be answered later. In case the patient has a medical emergency, then they should not call the physician office but rather call 911 or get to the hospital ER as soon as possible.

Patients are usually followed at two weeks, six weeks, three months, six months, and a year after surgery.

If the patient develops problems like chest pain, breathing problems, sudden neurological deterioration, or any other emergency they should call 911, or go to the emergency room directly. Patients who develop worsening pain at the surgery site, discharge from the wound, fever; they should call in the office.

Patients are usually asked to avoid bathing, until the incision heals, which may take two to three weeks. Patient can take shower after 72 hours of surgery with an impervious dressing in place. The dressing can be changes if the wound is visibly soaked. Patients are asked not to rub the area of surgery for about two to three weeks. They can gently dab it dry with a towel.

Patients with low demand work and desk job, can be back to work as soon as three to six weeks after the surgery depending on patient pain control as well as recovery. Patients who are in heavy lifting or control of heavy machinery or handyman job, may take three to four months, or even more to get back to work depending on their recovery from the surgery.

Patients after back surgery are usually started on physical therapy, if they need, depending on physician’s advice, at two to four weeks after the surgery. Many of the patients do not need physical therapy. A decision to go into physical therapy will depend on the surgery as well their recovery.

If the patient has a superficial infection, few days of antibiotics will help heal these infections. Occasionally patient may develop deep infection. In these patients may need IV antibiotics for a longer period. If despite all efforts or in patients with rapid deterioration due to infection, surgery may be needed to help clean off the infection.

Most of the patients do not need surgery and can be treated with conservative means. When the patients do not respond to conservative measures, or if they have worsening neurological deficit, or worse pain, they may need surgery.

Patients who develop neurological deficit in the form of weakness or involvement of bowel or bladder may have irreversible damage if the surgery is delayed enough.

When patient has back pain or has a surgery in which enough bone is removed to destabilize the spine, in these cases patient may need a fusion surgery to stabilize the spine, as well as to alleviate the symptoms.

General surgical risks of low back surgeries include bleeding, infection, persistence of pain, reversible/irreversible nerve damage leading to tingling, numbness, or weakness down the legs or involvement of bowel or bladder, failure of resolution of symptoms, failure of fusion, failure of implants. Most of the patients can undergo a safe surgery due to the development of vision magnification as well as refined surgical techniques. There are anesthesia risks also associated with this surgery.

Though these things depend on the type of surgery patient has undergone, patient can usually be progressively back to their normal activities, starting from three to five days from surgery. Patients are encouraged to take care of their activities of daily living, as well as light household activities. Patients can get back to driving once they are free from pain medication and are able to sit for a duration of period for driving, which may take upto 2-3 weeks or more.

The type of surgery depends on the presenting complaint, examination findings, as well as imaging findings in the form of x-ray and MRI. Some patients may need to undergo just discectomy, or laminectomy, while others may need a fusion surgery on their back to relieve their symptoms. To know more about the type of surgery, the patient needs to discuss this with their spine surgeons.

Spine surgeries like discectomy and laminectomy usually last about one to one and a half hours. Spine fusion surgeries, may take longer periods, up to two and a half to four hours or more. It depends on type of surgery, and as well as the level of spine to be operated upon.

Degeneration means gradual damage of the tissue. Degenerative disc disease represents aging of the disc, either appropriate to the normal age of the patient, or maybe accelerated due to injury or chronic disease, or other factors like smoking, obesity.

Lumbar instability means that the spine is not stable and there is excessive abnormal movement between two vertebrae. This is usually diagnosed by imaging in the form of X-rays, CT scan, or MRI of the patients. Instability may lead to compression of nerve roots causing radiculopathy with or without back pain.

Spinal Stenosis means narrowing of the spinal canal. It is can be at the cervical or thoracic or lumbar level. Most common spinal stenosis is at lumbar level and it, when narrowed, can compress nerves, causing pain going down the legs, with or without tingling, numbness, weakness, or involvement of bowel or bladder.

Sciatica is another name for lumbar radiculopathy, in which patient has pain going down their legs. The pattern of pain depends on the nerve root involved, but the most common is pain going down the outer side of the thigh and leg into the foot.

The diagnosis of Lumbar disc disease is made by history and examination of the patient. The confirmation of diagnosis is done by imaging in the form of X-rays and MRI. Occasionally the patient is having contraindication to MRI, patient may need to undergo a CT scan. When a CT scan is done, occasionally the patient may need to get injected with a dye before the CT scan and this is called CT myelography. Occasionally patient may need a CT scan along with MRI also.

Most of the patients get treated with conservative means. In case the patient is not getting relief despite continuous conservative measures, or if there is worsening of pain associated with or without weakness or involvement of bowel or bladder, the patient may need surgical intervention in the form of surgery.

Some patients are good candidates for minimally-invasive spine surgery and they can get better with that. History, physical examination, as well as special investigations like X-ray and MRI, are needed in order to discuss regarding options of minimal invasive spine surgery. Some patients are not good candidates for minimal invasive spine surgery and doing such a surgery in such patients may lead to non-resolved solution of the symptoms or worsening.

Warning symptoms of lumbar disc disease include worsening pain, tingling and numbness, development of weakness, or worsening of weakness, involvement of bowel or bladder in the form of incontinence of urine or stools, presence of fever, unintentional weight loss. In such conditions patients should immediately seek medical attention.

General blood workup is needed in most patients before the surgery. This will include blood counts as well as metabolic profile. Special tests may be needed in some patients if the physician has suspicion of some other disease. Most of the patients will have to undergo X-ray and MRI, or a CT scan before the surgery to confirm their diagnosis.

Common complications of a low back spine surgery are bleeding, infection, leak of cerebral spinal fluid temporary or permanent neurological deficits, blindness, worsening of pain, failure of fusion, failure of implants. There may be risks due to the anesthesia also.

Spine stabilization involves insertion of screws, rods, or plate to stabilize a spine. This surgery may be associated with fusion of the spine to be it a long-term solution to the instability of the spine.