Lumbar fusion surgery is performed to stabilize the spine and reduce pain by joining two or more vertebrae in the lower back.
A spinal fusion is designed to treat pain caused by spinal instability from spondylolisthesis or degenerative disc disease.
The most common motion segments treated are L4-L5 or L5-S1. A spinal fusion can also be done for multiple motion segments anywhere from L1 through S1.
A spinal fusion may be done using one of many approaches. Three common approaches are explained as follows: An anterior lumbar interbody fusion, referred to as an ALIF, is performed through a small incision in the lower abdomen .
First, the abdominal muscles and large blood vessels are carefully moved aside to access the spine. Next the damaged disc between the vertebrae is removed, and a spacer or cage filled with bone graft material is placed into the disc space. This spacer restores the height of the disc and helps create a solid fusion between the vertebrae.
Another common type of spinal fusion is a posterior lumbar interbody fusion, also called a PLIF. A PLIF is performed through an incision in the midline of the lower back. The back muscles, such as the erector spinae, are moved aside to access the bony arch, or lamina, of the spine. A portion of the lamina and sometimes part of the facet joint are removed to create space and relieve nerve pressure. The damaged disc is removed, and a cage with bone graft material is inserted into the disc space to stabilize the spine.
Sometimes a posterolateral gutter fusion, also called a posterolateral fusion or PLF, is the preferred approach. A posterolateral fusion sets up the fusion in the back of the spine, in an area known as the posterolateral gutters. Bone graft material is placed along the outer edges of the spine, near the transverse processes of the vertebrae. Screws and rods may be used to hold the vertebrae in place while the bone graft material promotes fusion.
In many cases, metal hardware, such as screws and rods, is used to provide additional support during the healing process. This hardware ensures that the vertebrae remain in the correct position while new bone forms and solidifies the fusion.
When multiple spinal segments are fused, it is termed a multi-level spinal fusion. There are many options for the fusion surgery, and all are done with the goal of stopping motion in a segment of the spine where motion creates pain.
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