Our Summary

This research paper discusses two surgical methods used to restore the natural curve of the lower spine (known as lumbar lordosis) in patients with degenerative spinal conditions. The first method is multilevel anterior lumbar interbody fusion, a procedure that gradually corrects the curvature of the spine over multiple levels. This method is less risky, but it requires the surgeon to be familiar with the anterior (frontal) approach to spinal surgery. The second method is pedicle subtraction osteotomy (PSO), which corrects the spinal curvature at a single point, requires only one approach and allows for simultaneous correction in multiple planes and open decompression of the spine. The paper offers guidance on when to use each technique.

FAQs

  1. What is the fundamental principle of spinal deformity surgery as mentioned in the article?
  2. What are the advantages and disadvantages of using multilevel anterior lumbar interbody fusion and pedicle subtraction osteotomy (PSO) in restoring lumbar lordosis?
  3. How does the article guide on the appropriate use of each technique for restoration of lumbar lordosis in patients with degenerative lumbar deformity?

Doctor’s Tip

One helpful tip a doctor might tell a patient about lumbar fusion is to follow post-operative rehabilitation and physical therapy recommendations closely to ensure a successful recovery and optimal outcomes. It is important to adhere to any restrictions on movement or lifting to allow the fusion to properly heal and to avoid putting excessive strain on the spine. Additionally, maintaining a healthy lifestyle with regular exercise and proper nutrition can help support the healing process and long-term success of the fusion surgery.

Suitable For

Patients with degenerative lumbar deformity, lumbar kyphosis, or sagittal imbalance are typically recommended for lumbar fusion surgery. These patients may experience symptoms such as back pain, leg pain, numbness, weakness, and difficulty walking due to spinal misalignment and instability. Lumbar fusion surgery aims to restore proper alignment of the spine, relieve pressure on the nerves, and improve overall function and quality of life. Patients who have failed conservative treatments such as physical therapy, medications, and spinal injections may be considered for lumbar fusion surgery. It is important for patients to undergo a thorough evaluation by a spine specialist to determine if lumbar fusion is the appropriate treatment option for their specific condition.

Timeline

Before lumbar fusion:

  1. Patient experiences chronic low back pain and/or leg pain that does not respond to conservative treatments such as physical therapy or medication.
  2. Patient undergoes diagnostic tests such as X-rays, MRI, or CT scans to determine the cause of their symptoms.
  3. Patient consults with a spine surgeon to discuss surgical options, including lumbar fusion.
  4. Patient undergoes pre-operative preparation, including medical clearance, physical therapy, and education on the surgery and recovery process.

After lumbar fusion:

  1. Patient undergoes the lumbar fusion surgery, which involves the removal of damaged disc(s) and fusion of adjacent vertebrae with bone graft or implants.
  2. Patient stays in the hospital for a few days for monitoring and pain management.
  3. Patient begins physical therapy and rehabilitation to regain strength and mobility in the lumbar spine.
  4. Patient may experience temporary pain and discomfort as the surgical site heals.
  5. Patient gradually resumes normal activities and follows up with the surgeon for post-operative appointments and monitoring of the fusion’s progress.
  6. Over time, the patient experiences improvement in symptoms such as back pain, leg pain, and mobility, as the fusion stabilizes the spine and reduces pressure on nerves.

What to Ask Your Doctor

  1. What is the goal of lumbar fusion surgery for my specific condition?
  2. What are the potential risks and complications associated with lumbar fusion surgery?
  3. How long is the recovery period after lumbar fusion surgery?
  4. Will I need physical therapy or rehabilitation after the surgery?
  5. What are the long-term expectations for pain relief and functional improvement after lumbar fusion surgery?
  6. Are there any alternative treatment options to lumbar fusion surgery that I should consider?
  7. How many lumbar fusion surgeries have you performed, and what is your success rate?
  8. What type of hardware or implants will be used in the surgery, and how long do they typically last?
  9. Will I need to make any lifestyle changes or modifications after lumbar fusion surgery?
  10. How often will I need to follow up with you after the surgery for monitoring and evaluation of my progress?

Reference

Authors: Chan AK, Mummaneni PV, Shaffrey CI. Journal: Neurosurg Clin N Am. 2018 Jul;29(3):341-354. doi: 10.1016/j.nec.2018.03.004. PMID: 29933802