Minimally Invasive Fusion
Why is this surgery done?
The most common reason for a lumbar fusion is instability of the spine resulting in a pinched nerve that may cause pain, numbness, weakness or a combination of these symptoms. A minimally invasive fusion is the same operation for the same reasons, but performed in a minimally invasive fashion, which causes less damage to the muscles and surrounding tissues.
How is minimally invasive fusion done?
There are many different techniques for performing a minimally invasive lumbar fusion. The surgery can be performed going through the front underneath the belly button, from the side underneath the rib cage or from behind. Minimally invasive surgery through the lower back typically means dilating a small pathway through the muscles rather than stripping the muscles away from the bones of the spine. There are special retractors designed to protect the muscles and cause less damage to these tissues, while performing essentially the same operation.
What are my risks? What are common complications?
General risks of all surgery include death, bleeding and infection. Surgical risks specific to lumbar fusion surgery include nerve root injury, a postoperative blood clot requiring surgical evacuation, tearing of the dural sac containing the nerve roots and spinal fluid, hardware misplacement, hardware failure, continued pain, worsening pain or the need for further surgery in the future.
What do I need to know before surgery?
Surgery is a patient’s choice. We are giving you our recommendation to help you with your symptoms, but there are no guarantees the surgery will give you the results you are hoping for.
Healthy nutrition plays a huge role in the healing process. Patients who have a healthy diet, exercise regularly and do not smoke have far better surgical results than those who don’t take proper care of their health.
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 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, these 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.
- Wean off narcotics after surgery as the pain subsides.
- 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?
Some people heal and recover faster than others. We are all different, and our problems are rarely exactly the same, no matter how similar they may seem. Surgery can be painful and often requires postoperative narcotics. We encourage patients to wean off these as soon as possible. It is important to avoid any movements or activity that put significant strain on your spine early in the healing process. Surgery can be done as an outpatient or with an overnight stay, depending on your overall health and certain other criteria. We want patients up and moving as soon as possible to avoid blood clots and to keep your muscles from getting weak. Some nerve symptoms improve immediately and some take a long time to recover. If there is nerve damage or a spinal cord injury, then you may not see a significant improvement with surgery. Your surgeon and his/her team will guide you through the recovery process and give you expectations about what activities are safe to perform postoperatively, at the different time intervals.
Possible physical therapy exercises
Some patients will see significant benefit from working with a therapist, and most patients who are more athletic may do fine with a list of acceptable postoperative activities given to them by their surgeon or his/her allied health provider. Those decisions are individual, and will be made with your surgeon postoperatively.