A spinal fusion surgery is designed to stop the motion at a painful vertebral segment, which in turn should decrease pain generated from the joint.
There are many approaches to lumbar spinal fusion surgery, and all involve the following process:
- Adding bone graft to a segment of the spine
- Set up a biological response that causes the bone graft to grow between the two vertebral elements to create a bone fusion
- The boney fusion – which results in one fixed bone replacing a mobile joint – stops the motion at that joint segment
For patients with the following conditions, if abnormal and excessive motion at a vertebral segment results in severe pain and inability to function, a lumbar fusion may be considered:
- Lumbar Degenerative Disc Disease
- Lumbar Spondylolisthesis (isthmic, degenerative, or postlaminectomy spondylolisthesis)
Other conditions that may be treated by a spinal fusion surgery include a weak or unstable spine (caused by infections or tumors), fractures, scoliosis, or deformity.
There are several types of spinal fusion surgery options. The most commonly employed surgical techniques include:
- Posterolateral gutter fusion – the procedure is done through the back
- Posterior lumbar interbody fusion (PLIF) – the procedure is done from the back and includes removing the disc between two vertebrae and inserting bone into the space created between the two vertebral bodies
- Anterior lumbar interbody fusion (ALIF) – the procedure is done from the front and includes removing the disc between two vertebrae and inserting bone into the space created between the two vertebral bodies
- Anterior/posterior spinal fusion – the procedure is done from the front and the back
- Transforaminal lumbar interbody fusion (TLIF) – Similar to the PLIF, this procedure is also done from the back of the spine
- Extreme Lateral Interbody Fusion (XLIF) – an interbody fusion in which the approach is from the side
It is important to note that with any type of spine fusion, there is a risk of clinical failure (meaning that the patient’s pain does not go away) despite achieving a successful fusion.