Considering lumbar fusion for lasting pain relief

Lumbar fusion surgery, a procedure aimed at alleviating chronic lower back pain, is increasingly common among individuals who struggle with conditions like degenerative disc disease, aiming to provide relief.

We speak to a renowned consultant neurosurgeon and spinal surgeon, who explores the key aspects of lumbar fusion surgery, including when it may be necessary and what to anticipate throughout the recovery process.

What is lumbar fusion surgery?

Lumbar fusion surgery is a procedure designed to alleviate pain in the lower back by permanently joining two or more vertebrae in the lumbar spine, which is the lower portion of the back. The vertebrae are small bones that stack up to form your spine. In lumbar fusion, these bones are fused together to eliminate motion between them. By doing so, the fusion stabilises the spine, which can reduce pain caused by certain conditions that result in instability or excessive movement.

In this surgery, a bone graft is typically placed between the affected vertebrae. Over time, the bone graft stimulates the growth of new bone, eventually fusing the vertebrae together. Metal plates, screws, or rods may also be used to secure the bones while they heal.

When may lumbar fusion be necessary?

There are several reasons your doctor might recommend lumbar fusion. The most common reasons include conditions that cause chronic pain or instability in the spine, which do not respond to other, more conservative treatments.

One of the main reasons for lumbar fusion is a condition called degenerative disc disease, which occurs when the discs between your vertebrae wear down over time, leading to pain and loss of stability. This is often age-related but can also be due to previous injuries or excessive strain on the spine.

Spinal stenosis is another common condition that may lead to lumbar fusion. In spinal stenosis, the spinal canal narrows and can compress nerves in the lower back, causing pain, tingling, or numbness in the legs. Lumbar fusion can provide relief by stabilising the spine after decompressing the affected area.

In some cases, lumbar fusion may be recommended for patients with spondylolisthesis, a condition in which one vertebra slips forward over the one below it. This condition can cause instability, pinching nerves and resulting in pain or difficulty with movement. Fusing the vertebrae together can restore stability.

What can you expect during the procedure?

Lumbar fusion is typically performed under general anaesthesia, which means you will be asleep during the surgery. The surgeon will make an incision to access the affected vertebrae. The exact approach can vary; for instance, the surgeon may operate from the back, side, or front of the body depending on the specifics of your case.

Once the affected area is accessed, the surgeon will remove any disc material or other tissues that need to be cleared. A bone graft will then be placed between the vertebrae. The graft may come from your own body (often the pelvis), from a donor, or it may be a synthetic material. After placing the graft, the surgeon will use metal hardware to hold the vertebrae in place, allowing the bones to fuse as they heal.

What are the risks and benefits of lumbar fusion?

Like any surgery, lumbar fusion comes with both potential risks and benefits. The primary benefit is pain relief and improved stability in the spine. Many patients experience a significant reduction in pain and an improvement in their ability to perform daily activities. Additionally, the procedure can help prevent further progression of the underlying condition.

However, risks are involved, including infection, blood clots, nerve damage, and ongoing pain despite the surgery. Some patients may also experience what is called adjacent segment disease, where the vertebrae above or below the fused segment experience increased stress and may degenerate over time.

How long does recovery take after lumbar fusion?

Recovery from lumbar fusion surgery can vary depending on factors such as your age, overall health, and the specifics of the surgery performed. Most patients stay in the hospital for a few days post-surgery, and physical therapy often begins shortly thereafter to aid in healing.

While initial recovery may take several weeks, the complete fusion process can take months to fully stabilise. During this time, you may be advised to avoid heavy lifting, bending, or twisting. Following your surgeon’s guidance on activity limitations and participating in recommended physical therapy can help you achieve the best outcome.

If you have persistent lower back pain or a condition that affects your spine's stability, lumbar fusion might be a suitable treatment option to discuss with your doctor. They can provide additional information tailored to your specific needs and help you weigh the potential benefits and risks.