Lumbar Interbody Fusion (Anterior, Transforaminal or Posterior)

This procedure is used to treat conditions such as spondylolisthesis, scoliosis, fractures and to relieve back and leg pain attributed to degenerative disc disease. The fusion is designed to stop movement in a painful vertebral area, and in turn reduce pain generated from the joint. Within all spinal fusion surgery either bone graft or a bone graft substitute is used to create a biological response whereby bone graft grows between two vertebrae in order to stop motion. The use of implants, cages, is also common in fusion surgery. In most cases metalwork i.e. rods and screws are needed to provide support to the vertebrae and spine whilst waiting for the bone graft to grow between the two vertebral bodies, creating a fused segment. After surgery and a recovery period most patients will not experience any limitations with movement having undergone a one level fusion. The surgeons use different approaches to this procedure; these are commonly abbreviated to ALIF, TLIF and PLIF. The approach will depend on what the surgeon wants to achieve and how this will be best achieved in relation to you.

ALIF

Anterior Lumbar Interbody Fusion - this procedure involves an incision through the abdomen.

TLIF

Transforaminal Lumbar Interbody Fusion - this procedure involves one or two incisions through the back. It is similar to PLIF, but involves the removal of the facet joint.

PLIF

Posterior Lumbar Interbody Fusion - this procedure involves an incision through the back, placing bone graft and or a cage (implant) directly in the disc space.

Hospital stay

On average patients will require a 7 – 10 day stay if they are undergoing a one level fusion. The first night post surgery will be spent in our High Dependency Unit (HDU). This enables staff to keep close observation and provide you with one-to-one care. Whilst in our HDU you will be encouraged to drink fluids and eat. You will be encouraged to sit up if able to and take deep breaths. Your observations will be regularly monitored. When the anaesthetist and surgeon are happy with your status you will return to the ward.

If recovery is sufficient, the day following surgery you will see one of our physiotherapists and commence mobilisation. The proceeding days you will be assisted to mobilise, each day mobilising more frequently and undertaking more tasks independently, such as washing and dressing.

During your stay you will be seen by the clinical nurse specialist daily. They will be able to answer any queries or concerns you may have.

Medication

On discharge you will be given approximately one week of analgesia and any other required medications. It is advisable that you continue taking your analgesia for at least two weeks post discharge. With most analgesia it is advisable to take a supplementary laxative, as all analgesia has a constipating side effect. If you require further medications your GP should be able to write a prescription. Alternatively, your consultant will prescribe if appropriate at your follow-up appointment. St Joseph’s Hospital provides an extensive range of pain management procedures, including nerve root injection, facet joint injections and caudal epidurals should they be required.

Mobility

In order to be discharged you need to be as independent as you were pre-surgery, if not more so.

It may be necessary to wear a corset or brace post surgery. This depends on your surgeon and the procedure undertaken. The corset may need to be worn for 6-12 weeks.

When sitting, a high backed armchair is preferential to a low chair or sofa. Initially sitting may be uncomfortable and it would be advisable to sit for no more than 20 minutes at a time until you are more comfortable.

Driving

Your surgeon will advise, however it is common to abstain from driving for six weeks following surgery. You must be able to do an emergency stop without hurting yourself and not endangering anyone else.

You are able to be a passenger in a car post surgery. It is advisable to sit in the passenger seat with the seat reclined and use a cushion for support if comfortable. If the journey is greater than 45mins have regular breaks and stretch your legs.

Flying

Your surgeon will advise, however it is common to abstain from flying for six weeks following surgery for short haul flights and 12 weeks for long haul flights. When flying it is advisable to recline your seat and regularly walk up and down the gangway.

Work

Your consultant will advise you on this, however 6-12 weeks of rest, away from work, is common. If possible graduate your return to work; a few hours a day for a few days a week. If absolutely necessary to take public transport travel at quiet times, early morning or late morning, avoiding rush hour. If you are in a sedentary job regularly stand and walk around. If you have an active job you may require a longer period off work and should consider lighter duties on your return.

Exercise

Walking is initially the best exercise for you; each day increase the amount of walking you undertake. Your consultant will not want you to undertake any formal physiotherapy until 12 weeks post surgery.

Do not lift anything over 3kg in weight. You must not bend or twist until advised otherwise.

Wound care

Your wound will have been closed with either clips or steristrips (paper strips) which will be removed 10-14 days post surgery. You will be advised pre-discharge of how to care for your wound. Ideally, the dressing should be changed every three days. You will have been given several spare waterproof dressings and may shower but not to bath. If you have clips in situ these will need to be removed by your practice nurse 10 days post surgery. Once the clips, or steristrips, have been removed the wound can be left uncovered and it is okay to get the wound wet.

Information given are guidelines and may vary from patient to patient.

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