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Lumbar Fusion
About Lumbar Fusion
Lumbar fusion is a surgical procedure used to treat specific problems that would not respond well to decompression surgery alone.
Lumbar fusion entails joining two or more lumbar vertebrae together. This has consequences for range of motion meaning less flexibility after the procedure. Many patients have already lost motion due to pain, instability or abnormal shifting of the spine, deformities like scolioisis, and disc degeneration. There are many different methods to perform lumbar fusion but the primary two options are traditional open lubar fusion vs more modern minimally invasive techniques. At Modern Spine, the choice is clear. We favor minimally invasive approaches in most cases.
A Minimally Invasive L4-5 fusion.
This surgery was done through three incisions all about 1 inch in length.
Indications for Lumbar Fusion
There are many indications for lumbar fusion. At Modern Spine, we not only explain the technique but go over your MRI and imaging to go over why a fusion might be your best option. When there is a choice between a Lumbar Decompression and a lumbar fusion for your condition, we carefully go over the risks and benefits of each approach and help you with this important decision.
Indications
- Recurrent lumbar disc herniations
- Lumbar instability or a condition known as spondylolisthesis (shifting of the spine)
- Lumbar degenerative disc disease
- Adjacent segment disease or failure of the levels next to a prior fusion
- Spinal deformity in the form of scoliosis or kyphosis
- Failed prior fusion known as pseudoarthrosis
- Severe spinal stenosis or narrowing around the nerves
- Severe lumbar joint arthritis known as facet arthropathy
- Infection of the spine
- Many more indications
Lumbar Fusion Facts
Fact 1
Fact 2
Fact 3
Fact 1
Open surgery has a relatively high risk of infection and almost universally causes permanent muscle damage.
Minimally invasive lumbar fusion has a lower than 1% infection rate, lower risk of serious complications, and a shorter length of stay in most cases.
Fact 2
Fusion limits motion but sometimes halting painful motion and correcting deformity is worth the trade off. The more levels fused, the more mobility will be lost.
Fact 3
Lumbar fusion can be very helpful for patients but it doesn’t help all conditions. In some patients, some symptoms do not improve. You must work closely with your surgeon to understand the goals of surgery and the recovery process which can sometimes be lengthy.
The Modern Spine Way
I was offered a lumbar fusion and told there were no other options. Do I really need one?
Many patients can be decompressed instead of fused. At Modern Spine, we carefully review your images and your options and present to you the pros and cons of each option. You decide your best option, and we do our best after that.
Traditional Open Fusion vs. Minimally Invasive Techniques
Open lumbar fusion involves making a large incision in the back, separating the muscles off the spine, and exposing the bones of the spine. Once visualized, the bone is drilling and then bone from a cadaver or from a separate location like the patient’s hip is removed and placed along the spine. Screws can be placed in this fashion to hold the bones together. The surgery usually entails significant risks with a relatively high chance of infection and transfusion due to the large surface area exposed. This is the most common method of fusion in the United States and has been for many decades.
Minimally invasive lumbar fusion is a modern form of surgery that involves making small incisions to perform similar work to an open surgery. The small approaches allow less disruption to the spine and the muscles around it. The technology has been around since around 2000 but is has not been widely adopted in the region. The same techniques are employed to obtain fusion but without the high risk of blood transfusion and infection. Patients also mobilize quicker and go home faster than with open lumbar fusion when minimally invasive techniques are used. This is the primary method used at Modern Spine because of the numerous advantages to patients compared to the traditional surgery.
Minimally Invasive Advantages
- Lower rates of infection, usually less than 1%
- Lower rates of transfusion
- Lower blood loss in most cases
- Shorter lengths of stay in the hospital and sometimes outpatient surgery is possible
- Sparing of the spinal musculature compared to open surgery
- A statistically significant lower risk of death from spine surgery
Minimally Invasive Approaches
A Modern Spine, we pride ourselves on being able to approach the spine in every way using minimally invasive techniques. You can research the various approaches more through the external links below. The procedures
ALIF
MIS TLIF
XLIF/DLIF/LLIF
OLIF
Prone LLIF
Percutaneous Screws
MIS Revision
ALIF
Anterior lumbar interbody fusion (ALIF)
This is an approach through a small abdominal incision. It allows placement of a large spacer to restore a collapsed disc.
Resources: Spine Universe ALIF (External Link)
MIS TLIF
Transforaminal lumbar interbody fusion (TLIF)
This is a posterior approach through one or two small back incisions.
Resources: Spine Universe TLIF (External Link)
XLIF/DLIF/LLIF
Extreme/Direct/Lateral Lumbar Interbody Fusion (XLIF/DLIF/LLIF)
This an a minimally invasive fusion technique that allows for a large footprint spacer to restore disc height through as small side incision.
Resources: Spine Universe LLIF (External Link)
OLIF
Oblique Lateral Lumbar Interbody Fusion
This is similar to LLIF but allows for a slightly angled approach to the spine. There are nuances to this approach and knowing the advantages of a wide variety of techniques is the Modern Spine way.
Resources: Barrow OLIF (External Link)
Prone LLIF
Prone LLIF
This is a new approach that is a variation of traditional LLIF. Modern Spine is one of the pioneers of this approach having contributed significant to the development of the technique.
Resources: Mayo Clinic OLIF (External Link)
Percutaneous Screws
Percutaneous screws
This technique uses small incisions to place instrumentation to hold the spine in place. The technique is very technical and requires extensive training and experience to perform properly. This is the primary method of placing spinal instrumentation at Modern Spine.
Resources: Columbia Perc Pedicle Screws (External Link)
MIS Revision
Most prior fusion patients are subjected to open surgery if they ever need surgery again on their spines. At Modern Spine, we pioneered techniques that allow minimally invasive hardware revision, extension, and correction. You will not find additional information about this because this is our specialty but you can consult with us to learn more.
The Modern Spine Strategy
I was told I have to have an open surgery to fix my problems. Is that true?
It is most likely not true. Most surgeons are not trained at the various approaches described above and just use the open approach as their only tool. At Modern Spine, we offer every approach and pick the one that suits your condition and the goals of surgery.
Next Steps
At Modern Spine, fusions are almost alway done in a minimally invasive fashion even revision surgery to repair or extend an older fusion. Get a referral from your docot or reach out using the Consult Today button below or Contact Us. We take self referrals and second opinions and consider ourselves honored if you choose us.