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Lumbar Spine Surgery: Lumbar Fusion
We are offering new hope for
patients suffering from mechanical back and/or leg pain secondary to spinal
cord or nerve root compression through lumbar spinal instrumentation, or LSI.
Patients most commonly present with a combination of spinal stenosis
(narrowing) and spondylolisthesis (slippage) of the lumbar vertebra causing
nerve compression. Spinal stenosis is most often seen in patients over 50 and
is secondary to degenerative changes that occur in the spine as a result of
aging. Spondylolisthesis most often occurs as a result of degenerative
changes, but can likewise be seen secondary to trauma to the lumbar spine, or
in those patients who are post-laminectomy. The levels most commonly involved
are L4-5 and/or LS-S1. Risk factors for these changes to the spinal column
include prior spinal or abdominal surgery, obesity, prior trauma or repetitive
injury, and cigarette smoking.
Patients
with degenerative spondylolisthesis typically present with a long and slowly
progressive history of low-back and diffuse bilateral leg pain that increases
with ambulation (walking). Patients will commonly say that the distance they
are able to walk has become shorter and shorter If the condition is left
untreated, it may simply become too painful for the patient to walk, and they
may then resort to the use of a wheelchair or other assistive device.
Patients
are considered for surgery when efforts at conservative treatment have failed
to relieve symptoms. Patients, who exhibit X-ray evidence of spondylolisthesis
or bone slippage and movement, are those most likely to benefit from LSI.
Outcome following LSI is generally better and more rapid if the patient is
diagnosed early, and surgical inter1vention is accomplished prior to muscle
atrophy and an inability to ambulate secondary to neural compression. LSI is
intended to decompress the area of stenosis as well as to prevent any
progression in the degree of spondylolisthesis. Generous foraminotomies are
performed in order to decompress the neural foramina (the area where the nerve
exits the spine). Only rarely is it necessary to realign the spine or reduce
the slippage in non-traumatic spondylolisthesis.
LSI was once thought to be too traumatic for the older patient. Concerns with
cardiac disease, pre-existing medical conditions or blood pressure instability
in a patient undergoing a lengthy and complex operative procedure
often-precluded consideration of surgery in the older patient. Our
neurosurgeons can perform this surgery in less than two hours and with minimal
blood loss. Natural bony fusion can only occur once the spine is stabilized.
Fusion rates have been shown to be excellent with the use of pedicle screws
for stabilization. Patients now ambulate the same day as surgery, so the
incidence of complications associated with immobility is greatly reduced.
As a result of decreased operative time, early post-op ambulation and adequate
pain control, the length of hospital stay for patients undergoing lumbar
spinal instrumentation has been decreased. This reduction in hospital stay,
combined with the low incidence of postoperative complications, has resulted
in increased patient satisfaction.
We
are currently using pedicle screw fixation with rods and crosslinks and
lateral bone fusion (See Picture). The average length of hospital stay is 4 to
5 days, with 90 percent of the patients then returning to their homes. Post-op
complications were rare, but will be reviewed prior to surgery. Most patients
have significant improvement in preoperative weakness at their one-month
post-op visit.
Overall, LSI generally is a safe and effective operation that is feasible for
nearly all patients diagnosed with symptomatic spondylolisthesis who are
refractory to conservative management.
Call, toll-free, at 412-630-7640 or 877-635-5234 to learn more.
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