A posterior fusion is performed on the lumbar spine when there is evidence of pain arising in the spinal discs or joints themselves and/or abnormal movement of the bones. The technique also allows the surgeon to decompress the nerves in the spine at the same time as performing the fusion operation.

Pre operative advice

48 hours before surgery, take some gentle laxatives (colace, senna) to ensure you have your bowels opened on the day of surgery.

On the day of your surgery it is important to remain Nil by Mouth (NPO). Do not eat past midnight the night before your operation. However you may continue to drink water up to two hours before admission, where you will be advised further.

It is not necessary to bring your medications with you, as these are supplied from Pharmacy at the hospital (you can use your medications when you return home). However, if you take a number of medications, please bring a list of names and doses so they can be appropriately supplied by the pharmacy department.

Please bring your scans with you to the Hospital.

How is this operation done?

This is performed under general anesthesia with the patient lying face down on a specially padded mattress. The incision is in the line of the spine over the affected disc or discs, and the spine is approached between the muscles. Some bone may be removed from the back of the spine to allow access to the disc space and decompress the nerve roots. Occasionally two vertical incisions are used, to allow separate access to both sides.

The surgeon may use metal (titanium) screws and bone graft to stabilise the spine and allow the bones to heal — the fusion. If an inter-body fusion is to be undertaken, material (usually a cage containing bone graft) is inserted into the disc space from behind. This has the effect of adding additional support to the disc space and allows a larger surface area for the fusion to occur across. The bone graft used is synthetic, which prevents the need for removing bone from the pelvis to act as a graft (the older technique — this was painful).

Post operative care

You will wake up recovery, where you will spend a short time recovering from the anaesthetic.

You will then be transferred back to the ward. The contact numbers and visiting times are listed below.

You will remain to be Nil By Mouth (NPO) until you begin having bowel sounds again. The bowels maybe slow to begin working again, and it is important not to eat or drink too quickly post operatively to avoid sickness and further complications. You will have maintenance fluids intravenously to keep you hydrated.

You may be given a Patient Controlled Analgesia pump (PCA). You will be given a button to press for a dose of pain relief from the pump, and there is a lockout period so it is not possible to have too much. This is an effective way of controlling your pain, especially while you can’t eat and drink.

On day 1 post operatively, you will be seen by the physiotherapy team on the ward. They will start teaching you how to safely get out of bed, and will help you to start walking again. You may feel lightheaded or dizzy the first few times you get up — this is normal, and will wear off. The physiotherapist may also fit you with a brace to support your spine. You will have to wear this for 6 Weeks. There may be opportunity to use he hydrotherapy pool during your inpatient stay.

Your wounds will be managed by the nursing staff; they will be dressed as needed. They will also provide you with the appropriate information for discharge.

When you go home

For the first 6-8 weeks, it is important that you take things easy. Do not start lifting or exercising during this period. You may walk about as pain allows, whilst wearing the brace, but not too vigorously. Several short walks, rather than one long walk.

You will not be permitted to drive for 6 weeks, until you feel fit to perform the emergency stop. You may not be insured! However you may be a passenger during this time, as long as you take regular rest periods to adjust your position.

Flying is not a problem, but airports are. Avoid carrying luggage, especially off the carrousel. Try to avoid sitting for too long — get up and exercise when it is safe to do safe. Please also check with your airline before flying.

With regards to working, please discuss this with your surgeon, as this varies depending on the work you do. Patients may return to work in a sedentary occupation when they feel comfortable. Those in manual jobs may need to be off work for longer, until the fusion is solid, as demonstrated by the x-rays.

The Nursing staff on the ward will have given you some information on wound care prior to discharge. If you have any concerns regarding you wound, please do not hesitate to contact us. The stitches are dissolvable and will not need removing. In general, all dressings can be changed after 72 hours, with a new dressing applied every day thereafter if the incision is draining. However, if no drainage is present, the dressing may be discontinued. Moreover, you may shower and wet the incision after 72 hours, but bathing or soaking the incision is not recommended for 2 weeks..

Pain killers can be constipating so we encourage you to eat food that will help to keep your bowels working well. Drink plenty of water.

Rehabilitation

From 6 weeks post op, assuming the x-ray appearances are satisfactory, you will start physiotherapy. These exercises are very gentle initially and increase over 6 weeks, so that by 12 weeks post-op you will be in the gym, swimming or cycling regularly.

Patients are seen at six weeks post-operatively and then at 3, 6 and 12 months with x-rays taken at each visit to determine the stage of healing. If metal screws are used these may be removed 1 — 2 years later, but this is usually not required.

Brace with Chairback lumbar support

After your operation you will need to wear a brace to support your muscles and spine (Similar to wearing a cast on your arm after surgery). It should be worn when you are out of the house, walking, shopping, when you are sitting in the car, bus, train or tube. You don’t need to wear it in bed or when you are sitting at home.

You may need to wear this for several weeks. You will be fitted with the appropriate size by the physiotherapist on the ward, and then be taught how to put it on correctly.

Skin care

• The brace should be worn over the top of a vest, or light t-shirt to prevent skin abrasions.
• Don’t wear any greasy or oily lotions, or talcum powder, and fully dry the skin before applying the brace.
• The brace may leave some small red marks on the skin. These should disappear within 30 minutes of removing the brace. This is normal, the skin will gradually build up resistance to the brace. If it does not disappear after 30 minutes, contact the clinic as below.
• Clean your brace regularly with a damp cloth and soapy water. Wipe and dry thoroughly before re-applying.