Our Summary

This study looked at the success rate of a two-level spinal fusion surgery in the lower back, specifically comparing surgeries performed only on the lumbar spine (L3/4/5) and those that also included the lumbosacral segment (L4/5/S). The researchers found that patients who had surgery on the lumbosacral segment had a significantly lower rate of successful fusion (64% compared to 96% in the lumbar-only group), and also reported worse outcomes in terms of mental health, lower back pain, and numbness in the buttocks or lower leg. The researchers therefore recommend using additional support for the sacral anchor in surgeries that include the lumbosacral segment to improve the success rate.

FAQs

  1. What was the success rate of the two-level spinal fusion surgery in the lumbar spine only?
  2. How did the success rate and patient outcomes compare between surgeries performed only on the lumbar spine and those that also included the lumbosacral segment?
  3. What did the researchers recommend to improve the success rate of surgeries that include the lumbosacral segment?

Doctor’s Tip

A helpful tip a doctor might tell a patient about lumbar fusion is to follow post-operative instructions carefully, including physical therapy exercises and proper lifting techniques to help promote successful fusion and prevent complications. It is also important to maintain a healthy lifestyle, including regular exercise and a nutritious diet, to support healing and overall back health. Additionally, it is important to communicate any concerns or changes in symptoms to your healthcare provider promptly.

Suitable For

Patients who are typically recommended lumbar fusion surgery include those with:

  1. Degenerative disc disease: Lumbar fusion may be recommended for patients with degenerative disc disease, which causes the discs between the vertebrae in the lower back to deteriorate and lose height.

  2. Spondylolisthesis: This condition occurs when a vertebra in the lower back slips forward onto the vertebra below it, causing instability and potentially compressing nerves in the spinal canal.

  3. Spinal stenosis: Lumbar fusion surgery may be recommended for patients with spinal stenosis, a condition in which the spinal canal narrows and puts pressure on the spinal cord and nerves.

  4. Herniated disc: A herniated disc in the lumbar spine can cause pain, numbness, and weakness in the lower back and legs, and lumbar fusion may be recommended if conservative treatments are not effective.

  5. Failed back surgery syndrome: Patients who have undergone previous lumbar surgeries that have not been successful in relieving their symptoms may be candidates for lumbar fusion.

  6. Traumatic injury: Lumbar fusion surgery may be recommended for patients who have experienced a traumatic injury to the lower back, such as a fracture or dislocation of the vertebrae.

  7. Tumors: Patients with tumors in the lumbar spine may require lumbar fusion surgery to stabilize the spine and remove the tumor.

Timeline

Before lumbar fusion:

  1. Patient experiences chronic lower back pain and possibly leg pain or numbness.
  2. Patient undergoes imaging tests such as X-rays, MRI, or CT scans to diagnose the cause of their pain.
  3. Patient may undergo conservative treatments such as physical therapy, medication, or injections to manage their symptoms.

After lumbar fusion:

  1. Patient undergoes pre-operative testing and preparation for surgery.
  2. Patient undergoes lumbar fusion surgery, which involves the fusion of two or more vertebrae in the lower back using bone grafts and hardware such as screws or rods.
  3. Patient is monitored in the hospital for a few days post-surgery to manage pain and monitor for any complications.
  4. Patient undergoes physical therapy and rehabilitation to regain strength and mobility in the lower back.
  5. Patient follows up with their surgeon for post-operative appointments and imaging studies to monitor the fusion process.
  6. Patient gradually resumes normal activities and may experience improvements in their lower back pain and leg symptoms over time.

What to Ask Your Doctor

  1. What specifically is lumbar fusion and why is it being recommended for me?
  2. What are the potential risks and complications associated with lumbar fusion surgery?
  3. What is the success rate of lumbar fusion surgery in general, and specifically for my condition?
  4. How long is the recovery process and what can I expect in terms of pain and mobility during that time?
  5. Are there any alternative treatments or therapies that I should consider before opting for lumbar fusion surgery?
  6. What type of rehabilitation or physical therapy will be necessary after the surgery?
  7. Will I need any additional support or hardware, such as screws or rods, for the fusion to be successful?
  8. How long do the results of lumbar fusion surgery typically last, and are there any long-term considerations I should be aware of?
  9. What are the chances of needing additional surgeries or treatments in the future after lumbar fusion?
  10. Are there any specific factors, such as the involvement of the lumbosacral segment, that could affect the success of the surgery in my case?

Reference

Authors: Fujimori T, Sakaura H, Ikegami D, Sugiura T, Mukai Y, Hosono N, Tateishi K, Fuji T. Journal: Clin Spine Surg. 2020 Dec;33(10):E512-E518. doi: 10.1097/BSD.0000000000001005. PMID: 32379078