Lateral Lumbar Fusion

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Lateral lumbar fusion is a surgical procedure which is performed due to leg and back pain. The goal of the procedure is to remove pressure from the spinal canal by fusing together the vertebrae which lie above and below the damaged disc.

Patients who have spinal stenosis or degenerative curvature of the spine with pain that radiates into the thigh, buttock and down the leg may need this surgery for relief of their symptoms if non-surgical treatments have been unsuccessful.

Surgical Process

General anesthesia is used during lateral lumbar fusion, so you will not be awake during the procedure. An incision will be made in your abdomen to allow your surgeon to operate on your spine. Once the doctor can see the damaged disc, he will remove it and fill the space left by the disc with medical fillers. The vertebrae just above and just below the space where the fillers were inserted are then stabilized in the correct position with surgical devices such as rods, plates or cages. These devices keep the spine in correct alignment and hold the vertebrae together while they heal.

Following surgery, your surgeon may order a brace to help support your spine and muscles. The brace is typically worn anytime you are out of your house. For example, when you are shopping or going for a walk, or when you are riding in a car or a bus. You usually are not required to wear the brace when you are sitting down at home or when you are in bed. Your surgeon will inform you when you can stop wearing the brace. This is usually determined by x-rays to see how you are healing.

You will be fitted for the brace while you are still in the hospital and hospital staff will teach you the correct way to apply it.

Pre-Operative Advice

Two days before your surgery, take a gentle laxative, such as colace or senna. This will help make sure your bowels are open the day you have surgery.

On the day you are scheduled for surgery it is important that you have nothing to eat. Do not eat anything after midnight on the night before surgery. Doctors and hospitals vary on how long prior to surgery you need to stop drinking water. You will be given pre-operative instructions that explain this. If you don’t understand something, be sure to ask your doctor.

All of your medications will be supplied by the hospital while you are a patient, so you do not need to take your medicines to the hospital. Do take along a list of the names and the doses of the medications you take.

If you have had any scans or tests, take those to the hospital with you also.

Post-Operative Care

You will wake up in the recovery room and spend a short time there to make sure your condition is stable. When you have recovered from the anesthetic you will be transferred back to your room.

You will remain NPO or “nothing by mouth”  until your bowel sounds return. It may take your bowels a little while to “wake up” from the anesthetic, so to avoid nausea and other complications, start eating and drinking slowly.

Your physician may order a Patient Controlled Analgesia (PCA) pump for you to use to manage your pain. The pump is connected to your IV (intravenous) line. When you are having pain, you can activate the pump by pressing a button and a dose of pain medication will be administered through your IV line. These pumps have a lockout feature that prevents overdose. PCA pumps are an effective way for patients to control post-operative pain.

Following surgery, the physical therapy team will begin working with you. You will learn how to get safely in and out of bed and with their help, you will begin walking. The first few times you are out of bed you may feel dizzy or lightheaded. This is normal and will go away as you regain your strength. Your physician may order a brace to help support your spine. The therapist will help with the fitting of this, and your doctor will provide you with instructions about when and for how long the brace will be required.

The nursing staff will care for your surgical incisions, re-dressing them as needed. They will also provide you with all the information and instructions you need before your discharge from the hospital.

Home Care

It is very important to your recovery that you give your body time to rest and heal for the first 6 to 8 weeks following your surgery. Do not exercise or do any lifting during this time. You may be up and walking around while wearing the brace, according to your doctor’s instructions, but take things easy. Instead of taking one long walk, try taking several shorter walks.

You can ride in a car as a passenger, but you will not be allowed to drive for at least six weeks. When you are riding as a passenger, be sure to make frequent stops to change position.

Flying is usually not a problem, but some of the circumstances that accompany flying can be. Do not carry luggage or try to retrieve it off the carousel. Avoid standing or sitting for extended periods. Move around as much as you can. Check with the airline prior to your flight to see what accommodations are available.

When you can return to work is something you will need to discuss with your doctor. A big part of this decision is based on what type of work you do. A person whose day is spent at a computer may be able to return to their job sooner than someone who works in the construction industry. Those in manual jobs may need to be off work longer, until the fusion is solid, as demonstrated by the x-rays.

The nurses will instruct you on how to care for your incision before you are discharged. If you have any questions, notify your surgeon or the hospital. Typically, new dressings are applied daily until the incision is no longer draining. Once the incision is dry and no drainage is seen on the dressings, the incision can be left open to air.

Pain medications can cause constipation, so be sure to drink lots of water and eat plenty of fresh fruits and vegetables or other foods that will keep your bowels moving.

Rehabilitation

Most often, surgeons recommend that patients begin physical therapy approximately six weeks following surgery if there have been no complications and follow-up x-rays show healing. Initially, exercises will be gentle but they will gradually increase so that by three months after your operation you will be bicycling, swimming or going to the gym on a regular basis.

Follow-up visits with your surgeon are typically scheduled six weeks after surgery and then every three months for one year. X-rays will be obtained at each appointment to make sure the vertebrae are healing and that the spine is in correct alignment.

Surgery Results

Most patients who have lateral lumbar fusion surgery experience an improvement in their level of pain, but there are many factors that have an effect on whether the operation is successful. For example, smoking has a negative effect on the success of the procedure because the bones might not heal. Osteoporosis is another factor that may affect the outcome of spinal fusion surgery. These factors should be thoroughly discussed with your surgeon prior to making a decision to have the operation.

Skin Care

In order to prevent any skin complications related to your brace, follow these instructions:

  • Do not wear the brace directly over your skin.  Always have a light t-shirt or undershirt under it. This will help prevent skin irritation and abrasions.
  • Be sure your skin is completely dry before applying your brace. Do not apply any lotions or powders to the skin that will be covered by the brace.
  • When you remove the brace, you may notice some small red areas on your skin. This is normal, and they should fade away within 30 minutes. If the redness does not disappear within 30 minutes after removing your brace, notify your surgeon.
  • Your brace should be regularly cleaned with soapy water and a damp cloth. Be sure to wipe it completely dry before re-applying.

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