- Lumbar Spinal Fusion Facts
- Lumbar (Lower Back) Spine
- What Is It
- How Does It Work
- Who's a Candidate
Minimally invasive lumbar spinal fusion facts
A minimally invasive surgical procedure, the spinal fusion is used to treat lumbar (lower back) pain if the pain hasn't resolved on its own after six to 12 weeks. A spinal fusion operation causes the vertebrae (bones of the spine) in the lower back to grow together, reduce pressure on the nerves, and reduce pain.
- The majority of patients with low back problems improves within six to 12 weeks regardless of treatment and do not need surgery.
- Minimally invasive lumbar spinal fusion attempts to achieve similar results to traditional techniques with less blood loss, less pain, less muscle damage and shorter hospital stay.
- Minimally invasive lumbar spinal fusion through the abdomen has not been as effective and has increased risk of nerve damage compared to traditional fusion techniques.
- Minimally invasive lumbar spinal fusion through the back has been shown in short term followup studies to be as effective as traditional techniques with less blood loss, less pain and shorter hospital stays, but additional studies of its long term effectiveness are needed.
Introduction to lumbar spinal fusion
- The lumbar spine is the lower portion of the spine found at the center of the curve of the low back, below the rib cage. This area can be a common source of pain.
- Low back pain is the second most common reason for visits to the family physician, behind the common cold. As people become older, various changes occur in the lumbar spine that can cause pain. In most cases these changes are due to normal degenerative arthritis (wear of cartilage over time).
- The physician must also rule out other more serious conditions including tumor, infection, scoliosis (curvature of the spine), spondylolisthesis (slippage of one spinal bone on another), or fracture.
- Fortunately, most patients with low back pain will have an improvement in their symptoms regardless of treatment within six weeks. During that time the physician has various treatment options including medications, physical therapy, or injections that can help ease the symptoms. Some of those patients that do not improve after six to 12 weeks may be candidates for surgery.
- The spine surgeon has different types of surgical options available based on the specific cause of pain.
What is lumbar spinal fusion?
- Lumbar spinal fusion is an operation that causes the vertebrae (bones of the spine) in the lower back to grow together. The goal of the lumbar fusion is to have the two vertebrae fuse (grow solidly together) so that there is no longer any motion between them.
- Removing the intervertebral disc (cushion between the bones) or bone spurs can reduce some of the pressure on the nerves, helping to reduce pain. By fusing the two vertebrae together, this may stop the formation of bone spurs at that location, further reducing pain and potential nerve injury.
- There are many different specific techniques to try to fuse the vertebrae together. The surgery can be performed either through an incision in the back, the abdomen, or a combination of both.
- In many cases, metal screws and rods are placed from the back into the bones to hold them in position while the fusion occurs. During an interbody fusion, the surgeon removes the intervertebral disc and places either a bone graft or a metal or plastic cage, or a combination of these in its place.
- The decision on what type of fusion is best for each patient is based on their specific complaints and the cause of symptoms. Spinal fusion can be very effective in the properly selected patient.
What is minimally invasive lumbar spinal fusion?
- Minimally invasive lumbar spinal fusion is similar to traditional lumbar spinal fusion, but it uses smaller incisions and causes less damage to the surrounding tissues during surgery.
- As with traditional lumbar spinal fusion, there are many specific techniques available to try to fuse the vertebrae together using minimally invasive techniques. This can be done through the abdomen, from the back, from the side, or with any combination of these.
- Minimally invasive lumbar fusion through the abdomen uses four small incisions, approximately ½ inch in length. A fiber optic viewing camera is used, similar to other minimally invasive procedures including laparoscopic gallbladder or appendix removal.
- Fusion with screws and rods can be performed through the back using several 1-2 inch incisions. In these cases a series of increasingly larger dilators (hollow tubes with solid inserts) are inserted through the incisions to help spread the muscles apart. Once the muscles have been moved away, the screws and rods can be placed through the dilator tubes. In some cases an operating microscope is used to help the surgeon see more clearly.
- One of the most recent advances in minimally invasive lumbar spinal fusion is the ability to perform fusion surgery through the patient's side. There are several techniques that allow the surgeon to make a small incision, approximately 2 inches in the patient's side, directly over the planned fusion site. The muscles are then carefully moved aside, and a series of increasing larger dilators are inserted down to the lumbar spine. Specialized instruments can then be used through the dilator tube to remove the intervertebral disc and place a bone graft or metal or plastic spacer in its place. This technique is typically combined with a procedure from the back to place rods and screws for additional support.
What are the advantages of minimally invasive lumbar spinal fusion?
- The major advantage of all of these minimally invasive techniques is that there is less damage caused to the surrounding tissues.
- Unfortunately, in traditional spinal surgery it is necessary to cut through muscles and move them out of the way in order to reach the spine. This can cause a large amount of pain following surgery, and it can lengthen the recovery time.
- Instead of cutting and moving muscles, the minimally invasive techniques can more gently spread through the muscles to allow access to the spine. This is much less painful for the patient, and it does not require as long of a recovery period for the muscle to heal.
- Another benefit of less muscle damage is less blood loss and thus a reduced need for blood transfusions using minimally invasive techniques. There is often less need for narcotic pain medications following this form of surgery, and a shorter hospital stay.
What are the disadvantages of minimally invasive lumbar spinal fusion?
- As with any new technique, one of the major disadvantages is the additional time needed to perform the procedure. While a surgeon may be very comfortable with the traditional surgical fusion techniques, it will take time to be able to achieve the same outcome using these new methods. Surgeons with more experience can now perform lumbar spinal fusion in equal or even less time than with the traditional techniques.
- Not all surgeons perform these techniques, so it may not be available from your current surgeon or in your area.
- Because this is a relatively new technique, many insurance companies consider this to be an investigational surgery and do not provide insurance coverage for it, so a patient should check with the insurer prior to surgery regarding coverage.
Latest Chronic Pain News
Daily Health News
How effective is minimally invasive lumbar spinal fusion?
- The results for the minimally invasive lumbar spinal fusion through the abdomen have not been as good as the traditional open anterior (from the front of the spine) fusion techniques. The success of the fusion has been less reliable, the operative times are longer and there are increased risks of injury to the nerves using the minimally invasive techniques. Because of this, many surgeons have stopped using this technique.
- The results of the minimally invasive procedures through the back have been much more promising. Experienced surgeons are able to perform lumbar spinal fusion through the back quicker, with similar fusion rates, less blood loss, and quicker recovery times than using traditional techniques.
- The newer minimally invasive lumbar spinal fusion techniques through the patient's side are still being refined. The initial techniques had some increased risk of damage to nerves, but more recent changes have made these even safer and more effective. The results so far are very promising for this technique, but there have been a limited number of studies. Additionally, since this was only recently developed, there are fewer surgeons performing this technique.
Am I a candidate for minimally lumbar invasive spinal fusion?
- First, you and your doctor need to determine if you are a candidate for spinal fusion.
- Remember, the majority of patients with low back pain recover within six weeks regardless of treatment.
- If you have had prolonged symptoms you should see your physician. If it is decided you may need surgery you will be referred to a spinal surgeon for further evaluation.
- If a fusion is thought to be potentially beneficial for you, the option of minimally invasive techniques can then be discussed with your surgeon.
Health Solutions From Our Sponsors
Medically Reviewed on 5/14/2021
Medically reviewed by Aimee V. HachigianGould, MD; American Board of Orthopaedic Surgery
Chou, Roger, M.D> "Subacute and chronic low back pain: Surgical treatment." UptoDate.com. Mar. 11, 2016.
Chou, Roger, M.D> "Subacute and chronic low back pain: Surgical treatment." UptoDate.com. Mar. 11, 2016.
Top Minimally Invasive Lumbar Spinal Fusion Related Articles
16 Back Pain Truths and MythsWhich mattress is best for back pain? Back pain conditions are very common. Learn the causes of upper and lower back pain. Find the truth and get the facts behind back pain myths, remedies, causes and treatment.
CT Scan (Computerized Tomography)A CT scan is an X-ray procedure that combines many X-ray images with the aid of a computer to generate cross-sectional and three-dimensional images of internal organs and structures of the body. A CT scan is a low-risk procedure. Contrast material may be injected into a vein or the spinal fluid to enhance the scan.
Chronic PainChronic pain is pain (an unpleasant sense of discomfort) that persists or progresses over a long period of time. In contrast to acute pain that arises suddenly in response to a specific injury and is usually treatable, chronic pain persists over time and is often resistant to medical treatments.
Degenerative Disc Disease and SciaticaDegenerative disc disease makes the disc more susceptible to herniation (rupture) which can lead to localized or radiating pain. The pain from degenerative disc or joint disease of the spine is usually treated conservatively with intermittent heat, rest, rehabilitative exercises and medications to relieve pain, muscle spasm and inflammation.
Electromyogram (EMG)Electromyogram or EMG is defined as a test that records the electrical activity of muscles. Normal muscles produce a typical pattern of electrical current that is usually proportional to the level of muscle activity. Diseases of muscle and/or nerves can produce abnormal electromyogram patterns.
Fractured Spine PictureFractures of the spine (vertebra) can cause severe "band-like" pain that radiates around from the back to the side of the body. See a picture of Fractured Spine and learn more about the health topic.
Low Back Pain ExercisesOne of the best low back pain treatments is exercise. Learn more about low back pain exercises--what works, and what doesn't. Discover severe low back pain relief through various gentle workouts designed to protect and strengthen the lumbar, core, and other related muscle groups.
Low Back Pain (Lumbar Spine Pain)There are many causes of back pain. Pain in the low back can relate to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.
Low Back Pain ReliefDo you suffer from low back pain? Learn more about common triggers of lower back pain like posture, exercise, and spondylosis. Find out about pain relief treatments like massage, yoga, stretching, exercises for back pain, and chiropractic medicine. See when surgery for back pain makes sense.
Lumbar Puncture (LP or Spinal Tap)A lumbar puncture or "LP" is a procedure whereby spinal fluid is removed from the spinal canal for the purpose of diagnostic testing. It is particularly helpful in the diagnosis of inflammatory diseases of the central nervous system, especially infections, such as meningitis. A lumbar puncture is also known as a spinal tap.
MRI (Magnetic Resonance Imaging Scan)MRI (or magnetic resonance imaging) scan is a radiology technique which uses magnetism, radio waves, and a computer to produce images of body structures. MRI scanning is painless and does not involve X-ray radiation. Patients with heart pacemakers, metal implants, or metal chips or clips in or around the eyes cannot be scanned with MRI because of the effect of the magnet.
Osteoarthritis (OA)Osteoarthritis is a type of arthritis caused by inflammation, breakdown, and eventual loss of cartilage in the joints. Also known as degenerative arthritis, osteoarthritis can be caused by aging, heredity, and injury from trauma or disease.
Pain ManagementPain management and treatment can be simple or complex, according to its cause. There are two basic types of pain, nociceptive pain and neuropathic pain. Some causes of neuropathic pain include:
- complex regional pain syndrome,
- interstitial cystitis,
- and irritable bowel syndrome.
Causes, Symptoms, Treatment for Spinal StenosisSpinal stenosis causes back pain, leg pain, difficulty walking and clumsiness. Learn the symptoms of lumbar spinal stenosis and cervical spinal stenosis and what surgeries are used for spinal stenosis treatment. Discover tips for relieving spinal stenosis pain without surgery, as well as useful medications.
Questions To Ask Before SurgerySurgery is the branch of medicine that employs operations in the treatment of disease or injury. Prior to surgery you might consider asking your surgeon questions about the operation (procedure).