Our Summary

This research paper is about how different types of back surgery can affect the curve of the lower spine, also known as lumbar lordosis, and segmental lordosis, which is the curve of a specific segment of the spine. The researchers looked at medical records of patients who had either posterolateral decompression and fusion (PLDF) or transforaminal lumbar interbody fusion (TLIF) surgeries between 2012 and 2020.

They found that the two types of surgeries had similar effects on the curvature of the spine in the period immediately after surgery and in the long term (after six months). Both surgeries initially decreased the curve of the spine, but this returned to near original levels after six months. In terms of the more specific segmental lordosis, the surgeries initially increased the curve, but this then decreased at the final follow-up.

Interestingly, they also found that patients who had the PLDF surgery experienced less loss of disc height (a measure of how much the spinal discs have compressed) after one year compared to those who had the TLIF surgery. Although some small changes in the curve of the lower spine may be noticed in the early postoperative period, these changes aren’t present a year later.

FAQs

  1. What are the two types of back surgeries discussed in this research paper?
  2. What impact do the PLDF and TLIF surgeries have on the curve of the lower spine and segmental lordosis in both the immediate and long-term period post-surgery?
  3. Did the researchers find any differences between the PLDF and TLIF surgeries in terms of disc height loss?

Doctor’s Tip

One helpful tip a doctor might tell a patient about lumbar fusion is to follow the postoperative rehabilitation plan carefully, including physical therapy exercises and restrictions on certain activities to help promote healing and prevent complications. It is important to follow up regularly with your healthcare provider to monitor your progress and address any concerns or changes in symptoms. Remember that recovery from lumbar fusion surgery can take time, so be patient and listen to your body as you gradually increase your activity level.

Suitable For

Overall, patients who are typically recommended lumbar fusion surgery are those who have severe back pain, instability in the spine, degenerative disc disease, spinal stenosis, spondylolisthesis, or other conditions that have not responded to non-surgical treatments such as physical therapy, medications, or injections. Lumbar fusion surgery is considered when conservative treatments have not provided relief and the patient’s quality of life is significantly impacted by their back pain.

It is important for patients considering lumbar fusion surgery to have a thorough evaluation by a spine specialist to determine if they are a good candidate for the procedure. This evaluation may include imaging studies such as x-rays, MRIs, or CT scans to assess the extent of the spinal abnormalities and help determine the best surgical approach.

Overall, lumbar fusion surgery can be an effective treatment option for patients who meet the criteria and have exhausted conservative treatments. However, it is important for patients to have realistic expectations about the potential outcomes and risks associated with the surgery. Consulting with a spine specialist can help patients make an informed decision about whether lumbar fusion surgery is the right option for them.

Timeline

Before lumbar fusion:

  1. Patient experiences chronic back pain and/or leg pain due to conditions such as degenerative disc disease, spinal stenosis, or spondylolisthesis.
  2. Patient undergoes imaging tests such as X-rays, MRI, or CT scans to determine the cause of their symptoms.
  3. Patient may undergo conservative treatments such as physical therapy, medications, and injections to manage their pain.
  4. If conservative treatments are unsuccessful, patient and their healthcare provider may decide that lumbar fusion surgery is necessary.

After lumbar fusion:

  1. Patient undergoes preoperative preparation, including medical evaluations and instructions on how to prepare for surgery.
  2. Patient undergoes lumbar fusion surgery, which involves the removal of damaged discs and the fusion of vertebrae using bone grafts or implants.
  3. Patient is closely monitored in the hospital for a few days after surgery to manage pain and monitor for any complications.
  4. Patient begins physical therapy and rehabilitation to regain strength and mobility in the spine.
  5. Patient follows up with their healthcare provider for postoperative appointments and monitoring of their recovery.
  6. Over time, patient’s pain and symptoms improve as the spine heals and stabilizes.

What to Ask Your Doctor

Some questions that a patient should ask their doctor about lumbar fusion include:

  1. What specific type of lumbar fusion surgery will I be undergoing (PLDF or TLIF)?
  2. How will this surgery affect the curvature of my lower spine and segmental lordosis?
  3. What are the potential risks and complications associated with this surgery?
  4. What is the expected recovery time and rehabilitation process after the surgery?
  5. Will I need physical therapy or other treatments after the surgery?
  6. How long will it take for me to see improvement in my symptoms after the surgery?
  7. How will this surgery affect my ability to participate in physical activities or work?
  8. Are there any long-term implications or considerations I should be aware of?
  9. What are the success rates and outcomes for patients who undergo this type of surgery?
  10. Are there any alternative treatments or options that I should consider before proceeding with lumbar fusion surgery?

Reference

Authors: Siegel N, Lambrechts MJ, Brush PL, Karamian B, Lee Y, Depalma M, Delvadia B, Song S, Toci GR, Canseco JA, Woods BI, Kaye ID, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD. Journal: World Neurosurg. 2023 Jun;174:e118-e125. doi: 10.1016/j.wneu.2023.03.005. Epub 2023 Mar 6. PMID: 36889640