Spinal Fusion- Lumber

1.  The goal of a spinal fusion procedure is to limit mobility at a problematic vertebral segment, which should lessen joint pain. The following procedure is used in all      lumbar spinal fusion surgical techniques:

• Implanting bone grafts in a spine section.
• Set up a biological reaction that causes the bone graft to expand between the two vertebral parts to fuse the bones.
• The boney fusion, which replaces a mobile joint with one fixed bone, prevents motion at that joint segment.

2.  A lumbar fusion may be considered for patients with the following diseases if aberrant and excessive mobility at a spinal segment causes severe pain and impairs          their capacity to function:

• Disc degeneration in the lower back.
• Spondylolisthesis of the back (isthmic, degenerative, or postlaminectomy spondylolisthesis).

A weak or unstable spine (induced by infections or tumours), fractures, scoliosis, or deformity are additional disorders that may be treated with spinal fusion surgery.

How Spinal Fusion Works

• Each level of the spine has paired facet joints in the back and a disc space in the front. Together, these structures constitute a motion segment and enable various motion velocities.
• An L4-L5 (lumbar segment 4 and lumbar segment 5) spinal fusion is actually a one-level spinal fusion because two vertebral segments must be fused together to stop the mobility at one segment. A 2-level fusion is a L4-L5, L5-S1 fusion.
• During a spine fusion procedure, bone graft is used to stimulate the growth of two vertebral bodies into one long bone. During the spine fusion procedure, bone graft might be created synthetically, harvested from cadavers, or extracted from the patient’s hip (autograft bone) (synthetic bone graft substitute).
• There are many different types of spinal fusions, including fusions using surgical approaches from the front (anterior), the rear (posterior), both front and back, and/or from the side, in addition to choices about which/how many levels to fuse and which bone graft to select.

Spinal fusion surgery comes in a variety of forms. The surgical procedures that are most frequently used include:

• Posterolateral gutter fusion: a back incision is used for this treatment.
• The surgery known as posterior lumbar interbody fusion (PLIF), which is performed from the back, involves removing the disc between two vertebrae and filling the empty space left by the disc with bone.
• Anterior lumbar interbody fusion (ALIF), which is performed from the front, involves removing the disc between two vertebrae and filling the empty space left by the disc’s removal with bone.
• spinal fusion from the outside in – Both the front and rear of the process are used.
• Lumbar interbody fusion through the transforaminal (TLIF) – This treatment is carried out from the back of the spine, just like the PLIF.
• Lateral extreme.

It is crucial to remember that, even with successful spine fusion, there remains a chance of clinical failure (in which case the patient’s discomfort persists).

The vast majority of the time, problems affecting just one vertebral segment respond best to lumbar spinal fusion surgery. After a one-level spine fusion, the majority of patients won’t experience any motion restrictions.

When pain is severe enough, fusing two levels of the spine may be a viable option. The removal of too much of the lower back’s natural motion and increased load on the remaining joints make a spinal fusion involving more than two levels unlikely to be pain-relieving.

Scoliosis and lumbar deformity are the two conditions most often treated by fusing three or more levels of the spine.

Successful Fusion

• A precise preoperative diagnosis, a technologically skilled surgeon, and a patient who leads a relatively healthy lifestyle (is not obese or a smoker) and is determined to seek rehabilitation and the restoration of his or her function are all necessary for a spine fusion to be effective.
• A variety of anterior and posterior surgical procedures, as well as a variety of devices, such as screws, spinal wires, artificial ligaments, vertebral cages, and artificial discs, may be used to stabilise and fuse the lumbar spine. Such devices are more frequently observed in routine radiologic treatment as spinal surgeries become more widespread. Radiography is the modality that is most frequently utilised to assess the postoperative spine. Alternatives like magnetic resonance imaging (MR imaging) and computed tomography (CT) may be helpful, however MR imaging of the postoperative spine is susceptible to metal-induced abnormalities. Radiologists must be conversant with the typical imaging appearances of the lumbar spine following stabilisation, fusion, and disc replacement with a variety of procedures and devices in order to make an appropriate postoperative assessment of spinal instrumentation and any problems.
• Spinal Fusion in Lumber links two or more vertebrae in a way that prevents mobility between them. The surgery aids in restoring spine stability and is used to treat fractures, age-related disc degeneration, and spinal stenosis. The removal of bone or herniated discs that are obstructing the spinal canal or pressing on nerves is frequently combined with spinal fusion surgery. Although this procedure limits movement, it is successful in relieving lower back and leg discomfort, numbness, and weakness.

The patient is given general anaesthesia during the procedure. The surgeon can choose from several methods depending on the repair:

• An abdominal incision is used during anterior lumbar interbody fusion (ALIF).
• Transforaminal lumbar interbody fusion (TLIF) is a procedure in which a cut is made in the back at an angle rather than directly over the injured or diseased vertebra.
• Direct lateral interbody fusion (DLIF), in which the patient’s belly is used as the point of access.

To access the fusion site, a single cut is made and muscle is displaced. A bone graft is implanted after each vertebra’s bones have been lightly sanded. The graft can be made of a variety of materials, including donor bone, bone extracted from the patient’s pelvis, and plastic or metal spacers. The graft material is placed between the vertebrae and then secured with rods and screws to create a cage that will support the patient until the fusion is complete. The area heals and becomes a single bone in a matter of months.

Depending on the size or location, minimally invasive surgery may be a possibility in addition to open or standard surgery. The recuperation period will be shortened and the incision will be substantially smaller. But it will take the same amount of time for the bone to fully recover.

Patients typically stay in the hospital after surgery for a few days to make sure the area is stable before going home. To provide additional support while the bones are fusing, patients occasionally have back braces placed. They are urged to engage in mild exercise like walking, riding, swimming, and other low-impact activities to stay active. A full recovery can take many months, depending on how many vertebrae were reconstructed.