Lumbar spinal fusion

Lumbar spinal fusion is surgery to join, or fuse, two or more vertebrae in the low back. The surgery is also called arthrodesis.

There are different methods of spinal fusion.

• Bone is taken from elsewhere in your body or obtained from a bone bank. Or sometimes human-made bone is used. The bone is used to make a bridge between vertebrae that are next to each other. This bone graft helps new bone grow.
• Metal implants are usually used to hold the vertebrae together until new bone grows between them.

Spinal fusion may be done by itself or along with surgery to remove bone and tissue that are narrowing the spinal canal and squeezing the spinal cord and/or the spinal nerves.

It may be done as a follow-up after surgery that was done to treat problems such as spinal stenosis, herniated discs, injuries, infection, and tumors.

Spinal fusion is often needed to keep the spine stable after injury, infection, or a tumor.

In general, studies don't show a clear difference between spinal fusion and structured rehabilitation for treating chronic low back pain from degenerative changes in the spine. This type of rehabilitation can include exercise, education, and cognitive-behavioral therapy.

As you decide about having spinal fusion, talk with your doctor about the benefits and risks.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• You may need to shower or bathe with a special soap the night before and the morning of your surgery. The soap contains chlorhexidine. It reduces the amount of bacteria on your skin that could cause an infection after surgery.
• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover.
• Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation. Walking may also decrease your muscle soreness after surgery.
• If advised by your doctor, you may need to avoid lifting anything that would cause excessive strain on your back. This may include a child, heavy grocery bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, or a vacuum cleaner.
• Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or aerobic exercise, until your doctor says it is okay.
• Do not drive for 2 to 4 weeks after your surgery or until your doctor says it is okay.
• Avoid riding in a car for more than 30 minutes at a time for 2 to 4 weeks after surgery. If you must ride in a car for a longer distance, stop often to walk and stretch your legs.
• Try to change your position about every 30 minutes while sitting or standing. This will help decrease your back pain while you are healing.
• You will probably need to take at least 4 to 6 weeks off from work. It depends on the type of work you do and how you feel.
• You may have sex as soon as you feel able, but avoid positions that put stress on your back or cause pain.

Diet

• You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
• Drink plenty of fluids (unless your doctor tells you not to).
• You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Medicines

• Be safe with medicines. Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.

Incision care

• You will be given specific instructions about how to care for the cuts (incisions) the doctor made. The instructions will depend on the type of materials used to close the cut.

Exercise

• Do back exercises as instructed by your doctor.
• Your doctor may advise you to work with a physical therapist to improve the strength and flexibility of your back.

Other instructions

• To reduce stiffness and help sore muscles, use a warm water bottle, a heating pad set on low, or a warm cloth on your back. Do not put heat right over the incision. Do not go to sleep with a heating pad on your skin.