Lumbar spinal fusion surgery
A spinal fusion surgery is designed to stop the motion
at a painful vertebral segment, which in turn should
decrease pain generated from the joint. All lumbar
spinal fusion surgery involves adding bone graft to
an area of the spine to set up a biological response
that causes the bone graft to grow between the two
vertebral elements and thereby stop the motion at that
segment.
For patients with the following conditions, abnormal
and excessive motion at a vertebral segment may result
in pain:
- Degenerative disc disease
- Isthmic, degenerative or postlaminectomy spondylolisthesis.
Other conditions that may be treated by a spinal fusion
surgery include a weak or unstable spine (caused by
infections or tumors), fractures, scoliosis or deformity.
How spine fusion surgery works
At each level in the spine, there is a disc space
in the front and paired facet joints in the back. Working
together, these structures define a motion segment
and permit multiple degrees of motion. Two vertebral
segments need to be fused together to stop the motion
at one segment, so that an L4-L5 (lumbar segment 4
and lumbar segment 5) spinal fusion is actually a one-level
spinal fusion.
A spine fusion surgery involves using bone graft to
cause two vertebral bodies to grow together into one
long bone. Bone graft can be taken from the patient's
hip (autograft bone) during the spine fusion surgery,
or harvested from cadaver bone (allograft bone). Synthetic
bone graft substitutes are also in development, and
one type - bone morphogenic proteins (which helps the
body create bone)—is currently being used for certain
fusion procedures.
In general, a lumbar spinal fusion surgery is most
effective for those conditions involving only one vertebral
segment. Most patients will not notice any limitation
in motion after a one-level spine fusion. Only
in rare cases should a three (or more) level fusion
surgery for pain alone be considered, although it may
be necessary in cases of scoliosis and lumbar deformity.
When necessary, fusing two segments of the spine may
be a reasonable option for treatment of pain. However,
spinal fusion of more than two segments is unlikely
to provide pain relief because it removes too much
of the normal motion in the lower back and places too
much stress across the remaining joints.
There are several types of spinal fusion surgery options,
including:
It is important to note that with any type of spine
fusion surgery, there is a risk of clinical failure
(meaning that the patient's pain does not go away)
despite achieving a successful fusion.
By: Peter
F. Ullrich, Jr., MD
September 8, 1999 (Updated January 20, 2004)
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