Our Summary
This research provides a detailed explanation and framework for a type of spinal surgery called single position surgery (SPS). This surgery is used to fuse together parts of the lower back (lumbar) spine.
One common method of this surgery, lateral lumbar interbody fusion (LLIF), has two main issues. Firstly, it often requires the patient to be moved onto their stomach for part of the surgery. Secondly, it doesn’t have a strong solution for fusing the L5/S1 level of the spine.
However, new strategies for this type of surgery have been developed. One method combines anterior lumbar interbody fusion (ALIF), LLIF and a type of screw fixation all while the patient is lying on their side. This is known as lateral single-position surgery (LSPS). Another method involves performing LLIF while the patient is on their stomach, a position more familiar to surgeons. This is called prone single-position surgery (PSPS).
The research describes the progression and reasoning of single-position spinal surgery and reviews studies that validate these methods. It also suggests an algorithm for single-position surgery that could help in the treatment of patients requiring AP lumbar fusions.
In summary, single position surgery in the fusion of the lumbar spine involves the patient staying in one position for the entire surgery. Initial studies have shown these methods to be effective.
FAQs
- What is single position surgery (SPS) in the context of lumbar fusion?
- What are the main issues with the lateral lumbar interbody fusion (LLIF) method?
- What are the new strategies for single position surgery and how do they differ from LLIF?
Doctor’s Tip
A helpful tip a doctor might tell a patient about lumbar fusion is to discuss the option of single-position surgery with their surgeon. This method can reduce the need for repositioning during surgery and may provide better outcomes. It is important to ask questions and understand all the options available for lumbar fusion surgery to make an informed decision about the best approach for your specific condition.
Suitable For
Patients who are typically recommended for lumbar fusion surgery include those with degenerative disc disease, spondylolisthesis, spinal stenosis, or other conditions that cause instability or compression in the lumbar spine. These patients may experience chronic back pain, leg pain, weakness, or numbness that does not improve with conservative treatments such as physical therapy or medication.
It is important for patients to undergo a thorough evaluation by a spine specialist to determine if lumbar fusion surgery is the best treatment option for their specific condition. Factors such as the location and severity of the spinal problem, the patient’s overall health and activity level, and their goals for treatment should all be considered when deciding on the most appropriate surgical approach.
Overall, lumbar fusion surgery may be recommended for patients who have a significant amount of pain or disability related to their spinal condition and who have not found relief with conservative treatments. By utilizing single-position surgery techniques, surgeons can provide effective treatment for these patients while minimizing the risks associated with traditional spinal fusion procedures.
Timeline
Before lumbar fusion surgery, a patient will typically undergo a series of diagnostic tests such as X-rays, MRIs, and physical examinations to determine the cause of their back pain and assess the extent of damage to the spine. They may also undergo conservative treatments such as physical therapy, medications, and injections to manage their symptoms.
After deciding to undergo lumbar fusion surgery, the patient will meet with their surgeon to discuss the procedure, potential risks, and expected outcomes. They will also undergo pre-operative testing to ensure they are healthy enough for surgery.
During the surgery, the patient will be placed under general anesthesia and the surgeon will make an incision in the back to access the affected area of the spine. The surgeon will then remove damaged disc material and bone, insert bone graft material to promote fusion, and stabilize the spine with hardware such as screws and rods.
After the surgery, the patient will typically stay in the hospital for a few days for monitoring and pain management. They will be given instructions on how to care for their incision, manage pain, and begin physical therapy to aid in their recovery.
In the weeks and months following surgery, the patient will gradually increase their activity level and work with a physical therapist to strengthen their back muscles and improve flexibility. It may take several months to fully recover from lumbar fusion surgery, but many patients experience significant improvement in their pain and function.
What to Ask Your Doctor
Some questions a patient should ask their doctor about lumbar fusion surgery, specifically single-position surgery, include:
- What are the benefits of single-position surgery compared to traditional methods?
- What specific technique will be used for my lumbar fusion surgery - LSPS or PSPS?
- What are the potential risks and complications associated with single-position surgery?
- How long is the recovery time for single-position surgery compared to traditional methods?
- Will I need physical therapy after the surgery, and if so, for how long?
- How successful have these single-position surgery techniques been in treating patients with similar conditions to mine?
- What is the expected outcome of the surgery in terms of pain relief and improved function?
- Will I need any additional surgeries or treatments in the future after undergoing lumbar fusion surgery?
- Are there any alternative treatment options to consider before proceeding with lumbar fusion surgery?
- What is the experience of the surgical team in performing single-position lumbar fusion surgeries?
Reference
Authors: Thomas JA, Menezes C, Buckland AJ, Khajavi K, Ashayeri K, Braly BA, Kwon B, Cheng I, Berjano P. Journal: Eur Spine J. 2022 Sep;31(9):2167-2174. doi: 10.1007/s00586-022-07229-4. Epub 2022 Aug 1. PMID: 35913621