This procedure is utilised to treat conditions such as spondylolisthesis, scoliosis, fractures and to relieve back and leg pain attributed to degenerative disc disease. The fusion is designed to stop movement in a painful vertebral area, and in turn reduce pain generated from the joint.
Within all spinal fusion surgery either bone graft or a bone graft substitute is used to create a biological response whereby bone graft grows between 2 vertebrae in order to stop motion. The use of implants, Cages is also common in fusion surgery. In most cases metalwork, i.e. rods and screws are needed to provide support to the vertebrae and spine whilst waiting for the bone graft to grow between the 2 vertebral bodies, creating a fused segment.
After surgery and a recovery period most patients will not experience any limitations with movement having undergone a 1 level fusion. The surgeons use different approaches to this procedure; these are commonly abbreviated to ALIF, TLIF and PLIF. The approach will depend on what the surgeon wants to achieve and how this will be best achieved in relation to you.
ALIF - Anterior Lumbar Interbody Fusion- this procedure involves an incision through the abdomen.
TLIF - Transforaminal Lumbar Interbody Fusion- this procedure involves 1 or 2 incisions through the back. Similar to the PLIF but involves the removal of the facet joint.
PLIF - Posterior Lumbar Interbody Fusion- this procedure involves an incision through the back. Placing bone graft and or a cage (implant) directly in the disc space.
Your Hospital Stay
On average you will require a 7 – 10 day stay if they are undergoing a one level fusion. The first night post surgery will be spent in intensive care (ICU) or High Dependency (HDU). This will enable staff to keep close observation and allow you to receive one to one care.
Whilst in ICU/ HDU you will be encouraged to drink fluids and eat if permitted to. You will be encouraged to sit up if able to and take deep breaths. Your observations will initially be regularly monitored. When the anaesthetist and surgeon are happy with your status you will return to the ward. The first day post operation, surgeon guidelines permitting you will be seen by the physiotherapist and commenced mobilising, very slowly. The proceeding days you will be assisted to mobilise, each day mobilising more frequently and undertaking more tasks independently, i.e. washing and dressing.
During your stay you will be seen by the clinical nurse specialist daily Monday to Friday and she will be able to answer any queries or concerns.
On discharge you will be given approximately 1 week of analgesia and any other required medications. It is advisable that you continue taking your analgesia for at least 2 weeks post discharge. With most analgesia it is advisable to take a supplementary laxative, as all analgesia has a constipating side effect.
If you require further medications your GP should be able to write a prescription or your consultant in your follow up appointment will be able to prescribe further medication. The Wellington provides an extensive range of pain management procedures, including nerve root injection, facet joint injections and caudal epidurals.
Prior to discharge you need to be as independent as you were pre surgery, if not better. You will be assessed mobilising up and down stairs safely. Several of the surgeons require there patients to wear a corset or brace post surgery. This depends on your surgeon and the procedure undertaken.
If wearing a corset this needs to be used when mobilising and sitting. It is not required when lying down. The brace may need to be worn when lying as well depending on your surgeon’s preference. The corset may need to be worn for 6-12 weeks. When sitting a high backed armchair is preferential to a low sofa. Initially sitting may be uncomfortable and it would be advisable to sit for 20 minutes at a time until you are more comfortable.
Driving: This is also at your surgeon’s discretion. 6 weeks is most common practise to abstain from driving. You must be able to do an emergency stop without hurting yourself and not endangering anyone else.
You are able to be a passenger in a car post surgery. Sit in the passenger seat, seat reclined and a cushion for support if comfortable. If the journey is greater than 45 minute, have a break, stretch your legs at regular intervals.
Flying: This can be discussed with your consultant. 6 weeks is a most common practise for short haul flights and 12 weeks for long haul flights. It is however at the consultants’ individual preference. When flying it is advisable to recline your seat and regularly walk up and down the gangway.
Return to Work
Your consultant will advise you on this, 6-12 weeks is advisable. If possible graduate your return to work; a few hours a day for a few days a week. If absolutely necessary to take public transport (e.g. the underground), travel at quiet times, early morning or late morning, avoid rush hour.
If you are in a sedentary job regularly stand and walk around. If you have an active job you may require a longer period off work and consider lighter duties on your return.
Walking is initially the best exercise for you; each day increase the amount of walking you undertake. Your consultant will not want you to undertake any formal physiotherapy until 12 weeks post surgery.
Do not lift anything over 3 kg in weight. No bending and no twisting until advised otherwise. No housework.
Your wound will have been closed with either clips or steristrips (paper strips) these are removed 10-14 days post surgery. You will be advised prior to your discharge of how to care for your wound.
Ideally the dressing should be changed every 3 days. You will have been given several spare waterproof dressings. You can shower but not to bathe yet. If you have clips in situ these will need to be removed by your practice nurse 10 days post surgery.You may need alternative arrangements if you do not have a practice nurse. Once the clips or steristrips have been removed the wound can be left uncovered and it is okay to get the wound wet.
All information given is guidelines and may vary from patient to patient.