Transforaminal = through the opening below the nerve
Lumbar = Low back, involving one or more of the last 5 intervertebral discs.
Interbody = Into the disc space.
Fusion = A bone graft is placed over spinal bone.
A fusion may be considered when your diagnosis is degenerative disc disease, internal disc disruption, or unstable spine.
An unstable spinal column allows one vertebral body to slip forward or backward above or below adjacent vertebra. This movement narrows the foramen, putting painful pressure on nerve roots.
Normal aging or trauma may cause changes in the bones and discs in the vertebral column, leading to a cascade of conditions that can affect nerve roots. This may cause back pain and sometimes nerve damage.
A problem inside the disc, Internal Disc Disruption, causes pain in the spine; this is believed to be due to leakage of irritating chemicals from the disc.
Back pain may be a primary complaint, and may be accompanied by hip and leg pain.
The interbody fusion may also be indicated when there is residual back pain after surgical removal of a disc herniation.
Research has resulted in new technology for treating back pain.
During surgery, most of the painful disc is removed and the PEEK cages are inserted into the disc space.
Cage size is selected to restore normal disc height in order to take pressure off compressed nerves. One of several substances may be placed inside the cages-your own bone (taken from the lamina, or the iliac crest of your hip), bone bank bone, (donated bone), or bone morphogenic protein (BMP), which is approved by the FDA for lumbar fusions.
As bone grows through the holes in the cage, fusion occurs, joining the vertebral bodies above and below. This results in a single joint rather than the previous one or two joints, depending upon the number of levels requiring surgery.
Under general anesthesia, an incision 5″ will be made in the back, through the muscles, down to the spine. The lamina will be removed, all or in part (this is the laminectomy part of the surgery), which then allows good access to the vertebral bodies, discs, and nerve roots.
Most of the disc (85% to 95%) will be removed thereby removing pressure from the nerves. A “spacer,” bone, or cages, will be inserted into the space between the vertebrae where the disc used to be in order to maintain appropriate room for nerves to exit. Bone will grow through holes in the cages, fusing the vertebral body above the disc to the one below.
If bone is used from the hip or from the bone bank, it will grow together, or fuse, with existing bone. The result is the same in either case: the spine is stable and pressure is taken off the nerves.
Additional posterior stabilization may be used with metal, such as rods and pedicle screws. The use of hardware or instrumentation is sometimes the best option your surgeon has to obtain the best results. The incision is closed and the patient is taken to the recovery room. A small drain may be left at the incision site for 1-2 days to remove excess fluid. Surgery for one disc usually takes 2 to 2 ½ hours. Additional levels can take as long as 3 hours total surgery time. Hospital stay is usually 2-3 days.
It is important to understand that this is major surgery; that is why you want to get better without surgery if possible. If pain is interfering with your life so that you cannot live your life in an acceptable way, then it is o.k. to consider surgery. Surgery is not dangerous, but it is not safe either. It is a little bit like driving in rush-hour traffic. If you are not willing to consider the risk, then surgery should not be considered.
Complications are rare, but they do occur. There is always risk with any surgery, and you need to be aware of possible risks and complications.
Before surgery, you will sign a “consent and disclosure” form stating that the risks have been explained and that you understand what surgery will be performed, and that you wish to proceed with the surgery. Listed will be 8 potential complications:
Please discuss any questions or concerns with your surgeon.
Minimally invasive lumbar fusion can now be performed with two small incisions (approx 2.5 cm) on both sides of the back, instead of one long incision. The procedure time may take slightly longer than traditional open surgery, but studies have shown that there is less pain, less blood loss, and patients often return to work sooner. The incisions are made a few centimeters away from the center of the back and a metal tube is passed down to the spine using X-ray guidance. The surgery is then performed in the same manner as a traditional open procedure.
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