Anterior Lumbar Fusion
Who needs this operation?
This operation is performed for back pain, when this is found to be coming from a disc rather than the other areas in the spine, such as the nerve roots or joints. This can be difficult to determine and may require careful investigation with MRI scanning. The aim of the operation is to fuse the vertebra above to the vertebra below the affected disc. This may be done at one or two levels (discs and neighboring vertebrae) as required and as determined by the investigations.
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 Nothing by Mouth (NPO). Do not eat past midnight the night before your surgery. However you may drink small amount of water to take any medications up to two hours before admission.
It is not necessary to bring your medications with you, as these are supplied from the 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.
Please avoid smoking on the day of your surgery.
Please shower or bathe as normal in the morning, and remove any make up or nail polish.
How is it done?
This is performed under anaesthetic (general), with the patient lying on their back. The spine is approached from the front, through the abdomen. This is achieved using a retro-peritoneal approach, thereby avoiding contact with the bowel altogether. The spine is then visualised and the blood vessels over it, the aorta and the vena cava can be gently retracted to gain access to the spine and, specifically the discs. The vascular team will perform this part of your operation.
Virtually the whole disc can then be removed and the spinal alignment can be restored using a series of distraction plugs in the disc space. The bones can then be fixed in position using a variety of devices – our favoured one is an interbody fusion cage, which locks the bones together and allows them to heal while maintaining the alignment of the spine.
Occasionally, a posterior fusion is coupled with this to provide further stability. 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.
Post operative care
You will wake up recovery, where you will spend a short time recovering from the anesthetic and then you will be transferred back to the floor.
You will remain to be Nothing 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.
On day 1 post operatively, you will be seen by the physical therapy team on the floor. 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 therapist may also fit you with a brace to support your spine. You will have to wear this for at least 2 weeks.
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, while wearing the brace, but not too vigorously. Several short walks, rather than one long walk.
You will not be permitted to drive for 4-6 weeks. However you may be a passenger during this time, as long as you take regular rest periods to adjust your position and wear your brace.
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 so. 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 floor 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. 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. You can take colace, senna and/or fiber to help with constipation.
From 2 weeks post op, assuming the x-ray appearances are satisfactory, you will start physical therapy. 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 2 and 6 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.
At your pre-op or first post-op appointment, you may be fitted for a bone stimulator. This device is used to aid the healing of your fusion and it also activates the body’s natural healing process.
What are the results?
Most people will have an improvement in their pain, but, obviously, there are many factors determining success. These need to be discussed in detail with your surgeon. SMOKING is known to badly affect the outcomes in fusion surgery as the bones may not heal. Osteoporosis may also affect the outcomes.
Brace with Lumbar support
After your surgery 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, or train. 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 therapist on the floor or at your pre-op visit, and then be taught how to put it on correctly.
- · The brace should be worn over the top of a vest, or light t-shirt to prevent skin abrasions.
- · Do not wear any greasy or oily lotions, or talcum powder, and fully dry the skin before applying the brace.
- · Clean your brace regularly with a damp cloth and soapy water. Wipe and dry thoroughly before re-applying.