Lumbar spine fusion surgery for degenerative disc disease
Overview of lumbar spine fusion surgery
A lumbar fusion is a type of back surgery that places bone either
in the front (disc space) and/or along the back (posterolateral gutter)
of the spine so that the bone grows together and fuses the spine. Fusing
the spine is designed to decrease back pain by limiting the motion at
a painful motion segment.
The spine fusion is not actually completed at the time of surgery. Instead,
the conditions for the spine to fuse are created and the fusion will set
up over a 3 to 6 month (and up to 18 month) period of time following the
spinal fusion surgery (see figure
1).
Lumbar fusion (or spinal fusion) surgery for back
pain caused by degenerative
disc disease is an option for patients who:
-
Have failed to get better after extensive conservative
treatment (such as physical therapy, medications)
-
Continue to have low back pain that limits their
ability to function
-
Have received a diagnosis that a specific disc
space is the pain generator
Importantly, other possible causes of low back pain
need to be considered and ruled out prior to the spine
fusion surgery. It is important to note that the decision
to undergo a fusion procedure for low back pain is
entirely the patient’s decision and he or she
needs to weigh the risks and possible complications,
as well as alternatives to a spine fusion surgery.
Historical perspective on spine fusion surgery
Fusion surgery for the treatment of lower back
pain has been done since the early 1900’s. At
that time, spine fusion procedures were done to limit
the deformity created by tuberculosis infections,
and it was found that not only did the fusion procedure
limit the deformity, it also reduced the patient’s
low back pain as well.
Since then, spine fusion procedures have had variable
popularity for the treatment of lumbar degenerative
disc disease and are still somewhat controversial.
Surgeons and researchers span the spectrum in terms
of their beliefs as to how useful spine fusion surgery
is and when and how it should be performed.
-
Some spine surgeons do not believe fusion surgery
is at all useful and is never indicated for the
treatment of low back pain from lumbar degenerative
disc disease.
-
Some spine surgeons are very willing to offer
patients a fusion procedure, and some spine surgeons
are even willing to do multiple level fusion surgery.
As with most things in medicine, the truth lies somewhere
in between the two far ends of the spectrum of beliefs
about spine fusion surgery for low back pain from
degenerative disc disease.
Indications for lumbar spine fusion surgery
Fusion surgery is best at treating low back pain
caused by severe degenerative disc changes and is
best for treating one, or maybe two, levels of the
lower spine (e.g. L4-L5 level or L5-S1 level). There
are definitely patients who have experienced dramatic
improvements in their activity tolerance and function
due to a successful lumbar spine fusion surgery.
Two key factors that impact on whether or not a fusion
procedure will be successful in reducing low back
pain include:
- Proper patient selection
for spine fusion surgery
- Obtaining a solid spine
fusion
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