| Lumbar Fusion
Click here to
see a video presentation which describes fusion surgeries and indications.
Lumbar fusions are commonly performed on patients who complain of significant
back or neck pain which has not responded to conservative treatment [such as
medications, injection, physical therapy, etc]. As fusions are relatively larger
surgeries with increased
risk factors, fusion surgery should always be considered as a last resort.
Fusions are most commonly used for patients with previous surgeries which have
failed, unstable spine, or degenerated spinal segments. Fusions are also used
in patients with tumors or fractures.
In order to fuse a spinal level, bone grafts [either from the patient or a
cadaver] and some type of metallic holding device [such as screws, cages, etc.]
The bone graft is placed in between the vertebrae and screws or cages are applied
to hold the vertebrae together until a solid fusion forms.
The success rate of obtaining a fusion may be as high as 90% or more depending
on the surgical approach taken. However, the success rate of pain relief in
patients varies dramatically depending on the diagnosis of the patient. As the
success rate of fusion is variable, fusions are usually only considered when
the patient is completely disabled by their back or neck pain.
In the lumbar spine, vertebrae can be fused by going through the abdomen [ie,
removing the disc and placing bone by opening the belly from the front!]. Figure
below shows a anterior [front] fusion with cages only.
Fusions can also be performed from the back where screws can be placed. The
figure below shows screws [marked by red arrows] and a cage [marked by white
arrow] placed into the spine by going through the back side of the patient.
At times, a combination of a front and back approach is used for
obtaining a fusion. The figure below shows cadaver bone graft placed from the
abdomen [marked by white arrows on the left image] with screws and rods placed
from the back side of the patient [marked by the blue and red arrows].