Frequently Asked Questions
Multilevel Lumbar Fusion
Most patients who require a lumbar fusion have severe degeneration of their lumbar spine, which may include collapse of the disc spaces, compression of the nerve roots, or misalignment of the vertebrae. These issues can cause also cause lumbar stenosis, where the area where the bones surround the nerves compresses the nerves. Patients will typically have back pain, pain in the legs (sciatica), and numbness, tingling, or weakness in the legs. Patients may also have claudication, which is difficulty walking long distances, which may be improved by leaning over a counter or a grocery cart.
An incision is made in the middle of the back, and a retractor is placed during the operation. The bone on the back of the involved vertebrae (the lamina) are removed. The joint between each two vertebrae are removed, which gives the surgeon access to the disc space. The disc between the vertebrae is removed and this is replaced with a plastic expandable cage. This cage is filled with the bone that was already removed (the lamina), and is also mixed with bone marrow which is obtained through a needle through the same surgical incision. After the expandable cage is placed, screws are placed into the vertebrae (pedicle screws) at each level, on each side.
The surgery itself takes between 3 and 6 hours of surgical time in the operating room depending on how many vertebral levels are involved, plus about 30-60 minutes to put the patient to sleep and in position for the surgery, and about 1-2 hours in the recovery room after surgery.
After surgery, the patient may have an epidural catheter, similar to what a pregnant patient will have during childbirth. This may help manage the pain in the first day or so after surgery. In some cases, a patient controlled analgesia (PCA) device is used. This is where a patient has a button that can be pushed which will administer a dose of narcotic pain medication through the IV. Both are not used at the same time. These are usually removed the day or so after surgery and then switched to oral pain medications.
The incision is closed with surgical glue, which should flake off over about a week or so. There are dissolvable stitches underneath the incision, and those will dissolve over about 8-12 weeks. The incision may be swollen initially after surgery, but this should improve with time. If there is redness, pus, or other drainage from the incision, please call our office.
After surgery, the pain that is radiating down the leg should improve relatively quickly (in hours to days), while numbness and tingling can takes days to weeks to improve. If the patient had difficulty with walking prior to surgery (claudication) this should improve as well. If there is significant weakness in the leg prior to surgery, this may take weeks or potentially months of rehabilitation and physical therapy to improve. The rate and amount of recovery is often dependent on the length of time that the nerve has been compressed, as well as the severity of the compression.
There will be pain in the back after surgery, and that may take several weeks to improve. The surgery will not make you feel like a teenager. The goal of surgery is to remove compression of the nerve to make the patient have less pain, numbness, tingling, or weakness in the legs, as well as to re-align the vertebrae to proper alignment.
The main restriction after surgery is no heavy lifting greater than 10 pounds for the first six weeks. The patient may be up walking, and otherwise participating in normal daily activities as much as tolerated.
Patients can typically return to driving once they are off narcotics, or are back to the baseline amount of pain medications that they were taking prior to surgery.
At six weeks, physical therapy is started, which can be done at the facility of the patient’s choice. Therapy is usually 2-3 sessions per week for up to six weeks, but depending on how well a patient is doing, it may be completed earlier or later. The amount of therapy that is covered by insurance is dependent on your particular insurance plan.
The entire recovery rate for a minimally invasive microdiscectomy is approximately 18-24 months. The patient is not in bed for this entire period of time, but it may take this long before full improvement is achieved.
With any surgery, there are risks and benefits. The benefit of the surgery is to remove the compression on the nerve to improve the pain, numbness, tingling, or weakness. However, there are always risks with any type of surgery. The risks of surgery includes but is not limited to bleeding, infection, stroke, paralysis, coma, death, pain, numbness, tingling, weakness, spinal fluid leak, failure of the bone to fuse, misplacement of the instrumentation, and need for future surgery.
If a spinal fluid leak occurs during surgery, it is repaired at the time of surgery either by suturing the areas that is leaking, or covering it with a type of “glue”. The patient is typically told to lie flat for several hours after surgery, and then the patient may be up and ambulatory.
If the leak persists, the patient may have headaches that are worse when sitting or standing upright, and which go away when the patient lies flat. If this happens, please call us and let us know.
Patients who smoke have a high rate of pseudoarthrosis, which means failure of the bone to fuse. Smoking decreases the amount of oxygen in the bloodstream, which causes the bones not to fuse. If this happens, then later on the screws will become loose, and additional surgery will be required to re-stabilize the spine. The best thing that the patient can do to prevent failure of fusion is to avoid smoking.
In male patients over 50, or who have a pre-existing history of prostate cancer, or enlarged prostate, the patient may have urinary retention. In some cases, this requires additional medication to aid with urination. In other cases, the patient may require catheterization. This typically improves over several weeks, and is most often due to the pre-existing prostate issues combined with anesthesia. It happens far less often in female patients.
If you have any questions, please feel free to contact us at your convenience.