If the spinal arthritis has progressed to spinal instability, the patient may require a combination of lumbar decompression (laminectomy) and lumbar fusion to stabilize the spine and alleviate chronic back pain. Lumbar fusion, also called spinal fusion, is a reliable surgery that has been performed for decades and is offered by the spine experts at Midwest Orthopaedics at Rush Minimally Invasive Spine Institute. During the surgery, Dr. Singh removes degenerated disc material and implants a bone graft, bone substitute or spacer between the vertebrae being fused. Fusion may also involve supplemental hardware, such as plates, cages, and screws to hold the spine in place. Once the union between the vertebrae has solidified, the hardware is no longer needed, but few patients are eager to undergo another surgery for their removal.
Lumbar fusion can be performed using the traditional open technique or minimally invasive methods. In traditional open spinal fusion surgery, the surgeon must make a large incision and cut through thick spinal muscles. In minimally invasive surgery, Dr. Singh is able to utilize special instrumentation that allows for a much smaller incision without cutting muscles.
Spinal fusion procedures involve removing the disc from between the vertebrae (in the disc space) and then filling the gap with a metal, plastic, or bone spacer. These spacers, also called cages, contain bone graft material that facilitates bone healing and fusion. After the spacer is implanted, the surgeon may use metal screws, plates, and rods to further stabilize the spine.
About 80 percent of all fusion surgeries involve one or two levels of vertebrae of the spine. Patients undergoing this type of fusion are very likely to be able to return to their normal activities after the surgery.
Dr. Singh at Midwest Orthopaedics at Rush Minimally Invasive Spine Institute may recommend spinal fusion to alleviate symptoms for many back conditions, including:
Lumbar fusion can be performed from the front (anterior approach), from the back (posterior approach) or from the side (lateral approach). The surgeons at Midwest Orthopaedic at Rush Minimally Invasive Spine Institute choose which approach is most appropriate based upon many factors, including the need for bone spur removal, the degree of instability, the medical condition, and body habitus of the patient. Usually the decision as to which approach makes the most sense involves a discussion of the pros and cons of each approach in a particular situation. The following are spinal fusion approaches that may be considered:
- Anterior Lumbar Interbody Fusion (ALIF) with Instrumentation
- Posterior Lumbar Interbody Fusion (PLIF)
- Transforaminal Lumbar Interbody Fusion (TLIF)
- Lateral Fusion Interbody Fusion (XLIF, DLIF)
Anterior Lumbar Interbody Fusion (ALIF) with Instrumentation: ALIF is used in the treatment of a disc problem that causes pain and instability in the lower back (lumbar spine). In ALIF, the procedure is performed from the front allowing Dr. Singh to access the spine without moving nerves and disturbing the back muscles.
Posterior Lumbar Interbody Fusion (PLIF): In PLIF, the surgeon approaches from the back by making one or two 2.5 cm incisions that provide access to the spine once the lamina (bone) is removed and nerves are retracted. In addition to spinal stenosis, PLIF is common in treating patients with:
Transforaminal Lumbar Interbody Fusion (TLIF): In TLIF, Dr. Singh uses the posterior (back) approach or the lateral (side) approach. The surgery is performed on one side only and the bone graft is inserted into the disc space laterally. The facet joints may be trimmed or removed to give nerve roots room. This approach requires less movement of nerves and opening of back muscles. The incision is 2 cm in length. In addition to spinal stenosis, TLIF is common in treating patients with:
Lateral Interbody Fusion (XLIF/DLIF): These procedures are being used to treat patients with spinal instability caused by degenerative discs, loss of height of disc space that causes pinching of a spinal nerve, change in normal curvature to the spine (scoliosis), and slippage of one vertebra over another. These procedures make use of the side (lateral) approach avoiding the spinal muscles and may take about one to one and a half hours to complete.