Our Summary

This study looks at a type of back surgery called pedicle subtraction osteotomy (PSO), which is a complex procedure that can help restore spinal alignment. However, there are still high risks of complications like false joint formation and the breaking of surgical hardware. Past research has focused on the stability provided by the surgery and the stress put on the hardware, but not much attention has been given to how the load is shared by the front part of the spine, which is crucial for healing after the surgery.

In this study, they used real spine segments and put them under different types of stress to test how the load is shared after the PSO surgery, looking at the front part of the spine as well as the hardware used in the back. They found that the stress on the front part of the spine significantly decreases after the surgery, which indicates that the load is being effectively shared by the back hardware. They also found that adding extra support rods can further decrease the stress on the back hardware, but only when used in conjunction with interbody cages (another type of surgical hardware). However, these extra rods didn’t affect the load on the front part of the spine.

This suggests that using extra rods and interbody cages could potentially increase the chance of successful healing after surgery by promoting load transfer across the surgically altered area of the spine. This could help explain why some clinical studies have reported higher healing rates and lower hardware failure rates when these techniques are used.

FAQs

  1. What is pedicle subtraction osteotomy (PSO) and how does it work?
  2. What are the risks involved in the PSO procedure?
  3. What is the role of the anterior column in promoting fusion after surgery?

Doctor’s Tip

A doctor may advise a patient undergoing lumbar fusion surgery to follow post-operative instructions carefully, including restrictions on certain activities and proper wound care. They may also recommend physical therapy to help strengthen the surrounding muscles and improve range of motion. It is important for the patient to attend all follow-up appointments to monitor the healing process and address any concerns promptly. Additionally, maintaining a healthy lifestyle with regular exercise and a balanced diet can support successful fusion and overall spinal health.

Suitable For

Patients who are typically recommended lumbar fusion are those with severe degenerative disc disease, spinal instability, spondylolisthesis, spinal deformities such as scoliosis, or those who have failed conservative treatments such as physical therapy and medications. Lumbar fusion may also be recommended for patients with spinal fractures or tumors. It is important for patients to undergo a thorough evaluation by a spine specialist to determine if lumbar fusion is the best treatment option for their specific condition.

Timeline

Before lumbar fusion:

  1. Patient undergoes a thorough evaluation by a spine specialist to determine the need for surgery.
  2. Pre-operative imaging such as X-rays, MRI, and CT scans are performed to assess the extent of spinal damage and plan the surgical approach.
  3. Patient may undergo pre-operative physical therapy and pain management to optimize their condition before surgery.
  4. Surgical consent is obtained, and the patient is instructed on pre-operative preparations such as fasting and medication adjustments.

After lumbar fusion:

  1. Patient undergoes the lumbar fusion surgery, which involves the removal of damaged disc material, insertion of bone graft or cages, and stabilization of the spine with rods and screws.
  2. Patient is monitored in the recovery room and then transferred to a hospital room for post-operative care.
  3. Patient may experience pain and discomfort in the days following surgery, which is managed with pain medication and physical therapy.
  4. Patient is discharged from the hospital once they are stable and able to care for themselves at home.
  5. Patient undergoes follow-up appointments with their surgeon to monitor healing progress and address any concerns or complications.
  6. Patient gradually resumes daily activities and physical therapy to strengthen the muscles surrounding the spine and promote fusion of the vertebrae.
  7. Patient may experience improvements in pain and mobility as the spine heals and fuses over the following months.

What to Ask Your Doctor

  1. What is the success rate of lumbar fusion surgery in terms of pain relief and functional improvement?

  2. What are the potential risks and complications associated with lumbar fusion surgery, such as pseudarthrosis and instrumentation breakage?

  3. How long is the recovery process after lumbar fusion surgery and what can I expect in terms of post-operative pain and mobility?

  4. Will I need physical therapy or rehabilitation after the surgery to help with recovery and strengthening of the back muscles?

  5. Are there any lifestyle changes or restrictions I will need to follow after lumbar fusion surgery to ensure the best possible outcome?

  6. How long does it typically take for fusion to occur after surgery, and how will this be monitored through follow-up appointments and imaging studies?

  7. Are there any alternative treatments or minimally invasive procedures that could be considered before opting for lumbar fusion surgery?

  8. What is the long-term outlook for my condition after lumbar fusion surgery, and what can I do to maintain spinal health and prevent future issues?

Reference

Authors: La Barbera L, Wilke HJ, Ruspi ML, Palanca M, Liebsch C, Luca A, Brayda-Bruno M, Galbusera F, Cristofolini L. Journal: Sci Rep. 2021 Feb 11;11(1):3595. doi: 10.1038/s41598-021-83251-8. PMID: 33574504