Arthrodesis of the lumbar vertebrae
Fusion of lumbar vertebrae is a surgical technique that allows one to join bones in the lumbar region of the spine in order to stabilize it and reduce pain or deformity.
What is arthrodesis of the lumbar vertebrae?
Arthrodesis of lumbar vertebrae allows unification of the bones of the lumbar spine with or without the insertion of metallic (steel or titanium) and non-metallic implants (screws, hooks, rods, plates). Since the bone unification is solid it requires a bone graft, which can be taken from the iliac crest, tibia or from one coast of the patient or from a donor or it may be of synthetic origin.
Which patients can undergo arthrodesis of the lumbar vertebrae?
The fusion of the lumbar vertebrae is indicated in cases of instability of the spine, degeneration of intervertebral discs or fractures.
What is required hospitalization?
The anterior approach is performed through an incision in the left part of abdomen or, alternatively, at the centre of the abdomen. The posterior approach is instead performed through an incision made at the central part of the back. The surgery is performed under general anaesthesia by operating on the patient's back. It is a lengthy operation that requires the patient to stay in the hospital for 2 to 5 days.
What are the advantages of arthrodesis of the lumbar vertebrae?
The anterior approach offers the advantage of affecting neither the back muscles nor the nerves. Moreover, it seems to ensure better results. The posterior approach has been successful in 60-70% of cases. Best results are obtained in the presence of a clear instability due to a fracture or spondylolisthesis.
Is the fusion of lumbar vertebrae painful and/or dangerous?
The surgeon's experience and specialization of the locations at which the arthrodesis of the lumbar spine is performed is critical to ensure the success of the intervention. The main risk is that the graft may not heal or the patient experiences a dislocation (most common in the absence of implants).
Furthermore, there is the possibility of damage to blood vessels directed towards the legs, bowel or ureter and in the case of men, retrograde ejaculation (for intervention in the vicinity of the vertebrae L5 and S1). Other possible risks include hernias, damage to the diaphragm, the kidneys, the roots of the nerves or spinal cord, bleeding and infection.
The healing process takes at least three months, during which support may be required, for example wearing a corset. In the meantime it will be necessary to monitor the healing process through radiographs. A CT (computer tomography) scan or a magnetic resonance imaging (MRI) may also be necessary. Physical activity should be resumed gradually and only three months after surgery one can begin to assess a rehabilitation intervention.
Standards of preparation
When admitted to the hospital before the procedure, the patient should bring the results of all tests carried out prior to the procedure and follow the directions given by the doctor regarding food and drugs that are routinely employed.