What is Lumbar Fusion?

Chronic lower back pain is an extremely common medical issue across the world. In a study conducted to determine the global prevalence of this health concern, approximately 19.6% of individuals aged 20 to 59 were found to experience chronic low back pain. 

Given the high prevalence of persistent low back pain among the adult population, various treatments have gained recognition in recent years. So, anyone who’s had chronic lower back pain has likely heard the term “lumbar fusion”. But, what exactly is lumbar fusion?

Here, we’ll answer that question, along with common queries about recovery from lumbar fusion and fusion alternatives

Lumbar Fusion

What is Lumbar Fusion?

Lumbar fusion is a surgical procedure performed on the lower, or lumbar, a portion of the spine. Its goal is to stabilize the back after spinal decompression surgery to relieve pain, restore mobility, and/or alleviate other symptoms of pinched nerves in the lower back.

The procedure is also called lumbar spinal fusion, or simply spinal fusion. It takes its name from the fact that two (or occasionally more) adjacent vertebrae are fused as a result of the procedure.

During spinal decompression, the surgeon trims away portions of a vertebra impinging on the pinched nerve. This compromises the strength of the vertebrae. So, lumbar spinal fusion surgery has traditionally been performed in conjunction with spinal decompression therapy to stabilize the spine. 

In lumbar fusion, the surgeon accesses the vertebrae to be fused and secures bone graft material in between them. During the recovery period, the bone graft material will stimulate the fusion of the vertebrae, causing them to combine into a single bone. 

Why is Lumbar Fusion Performed?

Conditions including spinal stenosis, spondylolisthesis, and degenerative disc disease can develop as a result of traumatic injuries or natural age-related degeneration. These spinal conditions can cause symptoms including tingling, numbness, pain, restricted mobility, and even paralysis.

The lower back is more susceptible to injury and degeneration because it’s subjected to bending, twisting, and other physical stresses throughout a lifetime. Poor posture can exacerbate the issue by misaligning the spine, which puts an additional impact on the lower back. 

Physical therapy, medication, and/or steroid injections can relieve many of the symptoms of these spinal disorders. However, when these therapies aren’t effective, a spinal decompression procedure to relieve pressure on these nerves may be recommended.

In short, lumbar fusion may be performed for common spinal problems in patients who don’t respond to six months or more of conservative treatment. 

How is Lumbar Spinal Fusion Performed?

There are several methods of fusion surgery, the most common of which are PLIF, ALIF, TLIF, and XLIF. 

  • PLIF

PLIF stands for posterior lumbar interbody fusion. With this method, the surgeon accesses the spine through an incision in the back. This is considered the traditional method of spinal fusion. Unfortunately, it requires the surgeon to pull the muscles away from the spine to access the spinal bones, which can trigger significant pain during the recovery process. 

  • ALIF

ALIF is an acronym for anterior lumbar interbody fusion. This method involves accessing the spine from the patient’s front, which is known as an anterior approach. The incision is made in the abdomen, then the surgeon moves aside intestines and large blood vessels to reach the spine. 

The benefit of ALIF is that it doesn’t agitate the large back muscles, which leads to a lower risk of injury and complications than PLIF. 

  • TLIF 

TLIF is short for transforaminal lumbar interbody fusion. This method of spinal fusion involves a posterior incision, meaning that it’s made in the back. But, unlike PLIF, the incision used in TLIF is made by way of the intervertebral foramen. 

With TLIF, the surgeon can complete a fusion on the front and back of the spine in one procedure. This is beneficial for patients because it’s less invasive, involves a lower risk of injury, and leads to less scarring. 

XLIF stands for extreme lateral interbody fusion. This method of spinal fusion is considered minimally invasive, making it a highly attractive option for modern patients. 

In XLIF, the surgeon first takes x-rays to find the exact position of the affected spinal disc. Then, the surgeon makes an incision in the patient’s side, completely avoiding the large back muscles and blood vessels that obstruct the spine in PLIF and ALIF surgery. 

XLIF leads to less blood loss, pain, and lumbar fusion surgery recovery time, as well as a shorter hospital stay.   

What Is The Success Rate of Lumbar Spinal Fusion?

Medical professionals often disagree about how to determine the success rate of lumbar spinal fusion. As a result, there are no standard criteria to calculate the success rate of a fusion procedure. Many physicians argue that while fusion successfully prevents spinal instability after decompression surgery, it does so at the expense of the patient’s mobility. 

So, while spinal fusion can help improve patients’ back pain by around 60% to 70%, it’s crucial to consider the lost motion at the fused vertebrae with this percentage.   

How Long Are You in Hospital After Spinal Fusion?

Spinal fusion typically requires a hospital stay of two to four days. This gives the affected vertebrae time to solidify.

During their time in the hospital, patients generally work with physical and occupational therapists to learn how to best carry out daily tasks (like standing, walking, and getting dressed) without disrupting the lumbar fusion recovery process. Additionally, your therapist will talk to you about the exercises to avoid after lumbar fusion.

Before discharging a spinal fusion patient, the hospital staff will make sure that their pain is effectively managed with medication; that there’s no indication of infection; that they can get out of bed and move without assistance; and that they can empty their bladder. 

Can You Live a Normal Life After Spinal Fusion?

The main drawback of lumbar fusion is that it eliminates the natural independent movement of the vertebrae. This inhibits patients from bending, flexing, and twisting the spine as they could before the procedure. Your doctor will advise you of this, as well as other lumbar fusion precautions before you undergo the surgery.

The degree of spinal mobility lost will depend on the location of the fused vertebrae, as well as the number of vertebrae that are fused. However, for many patients, fusion takes away their ability to partake in certain physical activities, such as sports and other athletics

After spinal fusion, some patients are no longer able to bend down and pick up items off of the floor. In this case, the patient will require special tools to retrieve objects. 

Other Downsides of Spinal Fusion

Additionally, it’s worth noting that patients may need as long as a year to fully recover from lumbar spine fusion. This lengthy recovery period can significantly impact patients’ quality of life.

In some patients, lumbar spinal fusion leads to a complication known as adjacent segment disease or ASD. With this condition, the vertebrae that are adjacent to the fused vertebrae degenerate at a faster rate. This is because the adjacent segments undergo added stress as a result of the fusion. 

Unfortunately, ASD can cause back pain, stiffness, and neurological symptoms like weakness, numbness, and tingling.  

What are the alternatives to lumbar fusion?

Non-fusion spinal implants are alternatives to lumbar fusion. Today the TOPS™ (Total Posterior Solution) System is one such implant that provides a clinically superior alternative to spinal fusion. It allows the individual vertebrae to maintain their full range of independent motion. 

This is just one reason why lumbar spinal decompression candidates must know exactly what lumbar fusion is, as well as the full range of treatment options available. If you suffer from chronic back pain, ask a spine specialist about the comprehensive selection of therapies at your disposal.