Lumbar Decompression and Fusion – Lateral/Anterior
Why is this surgery done?
Lateral/anterior lumbar decompression and fusion surgery is performed to take pressure off of the nerves in the lower back and to treat or prevent instability of the lower spine. This surgery is done for a variety of spine disorders, degenerative pathologies and trauma. Patients who are good candidates for surgery usually have back and leg symptoms- pain, weakness, changes in sensation and trouble standing up straight or walking distances.
How is lateral/anterior lumbar decompression and fusion surgery done?
During the procedure, a vascular surgeon may assist your spine surgeon.
For a lateral approach, you will be placed on your side on the operating table, with either your right or left side facing up. Your spine surgeon will make an incision between your ribs and hip crest, directly over the level of your surgery.
In an anterior approach, you will be on your back and the incision will be made in your abdomen (belly).
The vascular surgeon will move the abdominal contents (aorta and other important blood vessels) to the side to allow a better view of the spine. Next, to perform the spinal fusion surgery, your surgeon will remove the abnormal disc and replace it with bone, bone morphogenetic protein (BMP), an implant, a spacer and a cage or a combination of these products. The use of BMP will depend on the type of cage/spacer used.
In certain cases, posterior spinal instrumentation will also be needed for extra stability. In these cases, you will be repositioned during surgery to enable the surgeon to access your back and to place these posterior screws and rods. Your surgeon will explain the stabilization technique before your surgery. With this fusion and stabilization, the bone graft should grow together or fuse into a solid unit within 6 – 12 months.
What are my risks? What are common complications?
There is a risk of hernia, vascular injury, bowel injury, ureter injury or nerve injury. Your surgeon will discuss these risks with you. Please note that all surgery carries risks, and your surgeon would not recommend this approach if the risks outweighed the potential benefits.
After surgery and recovery, you may not feel you have gotten the kind of pain relief you expected. It is important to remember that there is no guarantee this surgery will provide the pain relief you want. As you and your surgeon discuss this procedure in the office, your condition and any risks for surgery complications will be assessed and fully explained to you.
While complications from surgery are uncommon, they can be serious and may include:
- Heart or lung problems from general anesthesia, which could be fatal
- Bleeding, which could require a transfusion
- Infection, which could require IV antibiotics and another operation
- Damage to the covering of the nerve, which causes a spinal fluid leak and could require a drainage procedure or another operation
- Damage to the nerves, causing paralysis or permanent nerve damage, although this is rare
- A change from leg pain to a disabling lower back pain
- Deep vein thrombosis (DVT).
The following long-term complications may occur:
- Nonunion (the vertebrae do not mend or fuse together as they should)
- Displacement of the fusion (the fusion shifts position)
- Failure of the medical hardware, which may require another operation
- Normal aging changes in the vertebrae adjacent to the fusion that are accelerated by the surgery
- Though rare, in men sterility may occur and prevent the ability to father children
What do I need to know before surgery?
Your personal lifestyle choices can have a significant effect on the healing process. Choices that lead to a decreased ability to heal or fuse properly include a poor diet, diabetes, lack of exercise and smoking cigarettes. In fact, some surgeons may choose not to perform this procedure while you are smoking. However, choosing a diet filled with fruits, vegetables and whole grains (instead of processed grains), as well as calcium and vitamin D3 will help the fusion process. If your daily diet does not include an adequate amount of calcium and vitamin D3, then you should consider taking a supplement.
Before your surgery, preoperative testing will need to be completed. To ensure medical clearance and testing such as blood work and EKG are completed, the surgical facility will contact you and schedule an appointment. If your surgery is scheduled at an outpatient surgery center, you may receive an order for preoperative testing to be done at your primary care office or local hospital.
This important checklist will help to ensure that you are prepared and ready for your surgery. Please read it and ask your surgeon if you have any questions.
- If you take any blood thinners—for example, Coumadin, aspirin, Plavix, Xeralto, Eliquis, Brilinta or Ticlid—make sure your surgeon is aware of this medication as soon as possible. You will be given specific instructions regarding any need to stop or change your current use of any blood-thinning medication. If necessary, your surgeon will get clearance from your cardiologist or other physician to ensure that this medication change is safe and appropriate for you based on your heart history, including prior heart attack, stent placement or open-heart surgery.
- One week before surgery, stop taking aspirin-based products and nonsteroidal anti-inflammatory drugs, (ibuprofen, Naprosyn, Naproxen, Advil and Motrin).
- Do not eat or drink anything after midnight the day of your surgery. This includes water, coffee, chewing gum and hard candies. You may brush your teeth with toothpaste the morning of surgery.
- Some daily medications may be taken the day of surgery with a sip of water. Medications that are appropriate to take the morning of surgery will be discussed with you by the hospital staff or your surgeon’s nurse.
When you decide to have this surgery, you will receive a surgery date and tentative surgery time. On the working day before your scheduled operation date (on Friday for a Monday surgery, for example), you will be called with the exact time for your surgery. Your surgeon’s office will call you by 3 – 5 p.m. to give you this time and make you aware of the time you need to arrive at the hospital. Because confirmed surgery times are unavailable to us until the day before your scheduled surgery, we appreciate your patience and understanding.
General discharge instructions
We recommend no driving for at least two weeks. You should be off all narcotics before driving.
No lifting greater than 10 pounds until your follow-up appointment.
No repetitive bending, twisting or lifting. These activities include laundry, sweeping, vacuuming, shoveling and yard work.
Smoking significantly interferes with healing. Do not smoke.
Walking is your primary exercise for the first month after surgery. Walk as your pain allows and avoid sitting for long periods of time.
Dressings may be removed 2 – 3 days after surgery. The dressing may be left off if the incision is dry. If drainage persists, change the dressing daily until the drainage has stopped. Once drainage has stopped, the incision may be left uncovered to air.
Leave Steri-Strips on the incision and allow them to fall off naturally. If Steri-Strips are not off by day 14, please take them off.
If staples or sutures were used, they will need to be removed 10 – 14 days after surgery. Please call office for an appointment.
You may shower any time after surgery, but keep the incisions dry the first two days. No tub baths, swimming or Jacuzzi tubs are allowed until your follow-up appointment.
Many patients notice constipation after a surgical procedure. This is due to general anesthesia, inactivity and narcotics. If using narcotics regularly, you should take a stool softener with laxative, such as Colace, Miralax or Senokot-S. These may be purchased over the counter.
What should I expect while recovering?
Postoperative pain is normal and it is important to get up and walk after surgery, even if you do not feel up to it. Walking helps with blood flow and activating the muscles, both of which lead to a quicker recovery. The pain is most intense in the first two weeks after surgery, with a gradual reduction after that.
Once the pain begins to subside and you no longer need a prescription pain medication, Tylenol and Tylenol-based products are safe to use. However, you should avoid nonsteroidal anti-inflammatory drugs (Celebrex, Motrin, ibuprofen, Advil and Aleve). These medications can be safely resumed 3 – 6 months after your surgery.
Ice may be used for discomfort as needed.
For the first month after surgery, daily walking is the best form of exercise. After your one-month follow-up appointment, a recumbent exercise bicycle and/or an elliptical trainer are reasonable forms of exercise. Once the incision has healed, you can also consider water aerobics and swimming. You should wait until your surgeon has seen your incision before getting in the pool. It is important to avoid bending, lifting and twisting with your lumbar spine during the first three months of the healing process. This would include activities such as jogging, golf, tennis, yard work and construction work.
Possible physical therapy exercises
After leaving the hospital, physical therapy is not necessary for most patients. Your best therapy is walking. Try walking on a structured basis, beginning slowly at first and progressing on a regular basis as your pain begins to lessen.
If your recovery is slower, you may need additional therapy after surgery. If needed, physical therapy will be discussed with you at your follow-up appointment. Be aware that physical therapy will not begin until fusion has occurred, 3 – 6 months after your surgery.