360° Fusion Surgery (Anterior and Posterior)
Fusion Surgery Description
Fusion surgery a spinal surgery for low back pain or lumbar pain that requires the surgeon to stabilize both the front and back of the spine. Fusion surgery is only considered once all conservative measures have failed to provide significant back pain or neck pain relief. The front, or anterior, procedure is often performed first. This is the same as an anterior lumbar interbody fusion (ALIF). After this procedure is completed and bandages are placed over the operative area, the patient is gently rolled over for the second part of the surgery. This is the same as a posterior lumbar fusion (PLF). Pedicle screws and rods may be placed during the posterior portion of the surgery.
Conditions Treated with Fusion Surgery
Combined anterior/posterior fusion surgery is used to treat a variety of spinal problems including painful disc degeneration, spondylolisthesis and spinal deformity as well as for patients with previous spine surgery.
What to Expect Before the Fusion Surgery
Once you have decided to have surgery, the following events take place:
- A medical examination.
- Chest X-ray, EKG and blood work.
- You may be asked to have a neurological or psychological examination.
- If taking aspirin or anti-inflammatory medications daily, stop these medications at least one week before surgery.
- If you take prescription medications or other drugs, including herbals, ask your doctor how soon before fusion surgery you should stop taking these.
- Do not have anything to eat or drink for 6 to 8 hours before surgery.
- You will check into the hospital the morning of fusion surgery.
- Prior to surgery, you will be asked to sign permits for surgery, anesthesia, blood and blood products.
What to Expect During the Fusion Surgery
- An incision is made by a general surgeon in the abdomen to expose the front part of the spine.
- Fluoroscopy (live X-ray) is used to determine the correct level(s) to be operated.
- The disc is approached after carefully separating away the abdominal contents and major blood vessels are moved off to the side.
- The disc is removed.
- A fusion cage or wedge of bone is placed in the disc space.
- Normal compression of the spine will hold the bone or cage in place. A screw may be placed into the vertebrae to act as additional support.
- After the anterior fusion is completed and the incision closed and bandaged, you will be gently rolled over on the operating room table and prepared for the posterior lumbar fusion.
- An incision is made in the low back area.
- Fluoroscopy is used to determine the correct level(s) to be operated.
- Bone graft is placed along both sides of the back part of the spine.
- Pedicle screws may be placed in the vertebrae above and below the level to be fused.
- The screws are connected with rods.
- Surgery takes approximately 2-5 hours.
What to Expect After the Fusion Surgery
- You will be in the recovery room from 1 to 1½ hours.
- The surgeon will contact your family while you are in recovery.
- After going to a hospital room, you will be able to use a PCA pump to get medication for pain control. This machine controls the amount of medication that can be received.
- Staff will usually get you out of bed shortly after surgery.
- The hospital stay is usually 2-3 days.
- A brace or corset is prescribed to restrict bending and promote healing of the fused area.
- You will be given any needed prescriptions and discharge instructions.
- A set of exercises that you can do at home will be provided.
- You will be able to ride in a car or plane upon leaving the hospital.
- It is important to avoid twisting and bending backward.
- Physical therapy is usually initiated after the first office visit with your doctor following surgery.
Recovery from 360° fusion surgery varies greatly among patients and is dependent on the extent of the surgery as well as the age and health of the individual. Return to work also varies greatly among patients and is related to overall health and the type of work you do. It is important to note that back pain is seldom completely eliminated – the objective with fusion surgery is to reduce pain.