Posterior fusion procedures�in the lumbar spine are used to treat spine instability, severe degenerative disc disease and fractures in the lumbar spine. Other procedures are usually done along with the spinal fusion to take the pressure off nearby nerves.

Patients are given a general anesthesia to put them to sleep during most�spine surgeries. As you�sleep, your breathing may be assisted with a ventilator. A ventilator is a device that controls and monitors the flow of air to the lungs.

During surgery the patient usually kneels face down on a special operating table. The special table supports the patient so the abdomen is relaxed and free of pressure. This position lessens blood loss during surgery. It also gives the surgeon more room to work.

An incision is made down the middle of the low back. The tissues just under the skin are separated. Then the small muscles along the sides of the low back are lifted off the vertebrae, exposing the back of the spinal column. Next, the surgeon takes an X-ray to make sure that the procedure is being performed on the correct vertebrae.

The�surgeon�first removes any pressure from nearby nerves. The lamina is one that forms the back portion of the bony ring which covers the spinal canal. The surgeon now removes part or all of this lamina bone. After this, the surgeon then removes any disc fragments and scrapes off the surrounding bone spurs. This ensures that the nerves inside the spinal canal are relieved of additional tension and pressure. The nerve roots are then checked to see if they move freely in the spinal canal and as they leave the spine through the small holes between the vertebrae, the neural foramina. If not, the surgeon may cut a larger opening in the neural foramina. This procedure is called�foraminotomy.

The�surgeon�first shaves a layer of bone off the back surfaces of the spinal column. There may be some bleeding at the site where the bone is cut. The surgeon makes a second incision at the hip. A bone graft is made by removing small strips of bone from the top frame of the pelvis. The surgeon lays the bone strips over the back of the spinal column. When the bone graft contacts the bleeding area, the body heals (or fuses) the bones together just as it would a fractured bone.

During posterior spinal fusion, the surgeon also fixes the bones in place using a combination of metal screws, rods and plates. This instrumentation (or hardware, as it is sometimes called) holds the vertebrae to be fused together and prevents them from moving. The less motion there is between two bones trying to heal, the higher the chance they will successfully fuse. The use of instrumentation has increased the success rate of spinal fusions considerably.

As with all major surgical procedures, complications can occur. Some of the most common complications�following posterior lumbar fusion include

• Problems with anesthesia
• Thrombophlebitis
• Infection
• Nerve damage
• Problems with the graft or hardware
• Muscle disruption
• Non-union
• Ongoing pain

This is not intended to be a complete list of the possible complications.

Problems with Anesthesia

Problems can arise when the anesthesia given during surgery causes a reaction with other drugs the patient is taking. In rare cases, a patient may have problems with the anesthesia itself. In addition, anesthesia can affect lung function because the lungs don't expand as well while a person is under anesthesia. Be sure to discuss the risks and your concerns with your anesthesiologist.

Thrombophlebitis (Blood Clots)

Thrombophlebitis, also known as deep�venous thrombosis (DVT), can occur after any operation. It occurs when the blood in the large veins of the leg form clots. This can cause swelling to the leg which then becomes warm to the touch and painful. There is a risk of the blood clots in the veins breaking apart and traveling to the lung, where they lodge in the capillaries and cut off the blood supply to a portion of the lung. This condition is called a pulmonary embolism. Most surgeons take preventing DVT very seriously. There are many ways to reduce the risk of DVT, the most effective being, getting the patient to move around as soon as possible. Other other commonly used preventative measures include:

• Pressure stockings to keep the blood in the legs moving
• Medications that thin the blood and prevent blood clots from forming

Infection

Infection following spine surgery is rare but can be a very serious complication. Some infections may show up early, even before you leave the hospital. Infections on the skin's surface usually go away with antibiotics. Deeper infections that spread into the bones and soft tissues of the spine are harder to treat. They may require additional surgery to treat the infected portion of the spine.

Nerve Damage

Any surgery that is done near the spinal canal can potentially cause injury to the spinal cord or spinal nerves. Injury can occur from bumping or cutting the nerve tissue with a surgical instrument, from swelling around the nerve, or from the formation of scar tissue. An injury to these structures can cause muscle weakness and a loss of sensation to the areas supplied by the nerve.

Problems with the Graft or Hardware

Posterior fusion surgery requires bone to be grafted onto the spinal column. The graft is commonly taken from the top rim of the pelvis. There is a risk of pain, infection, or weakness in the area where the graft is taken.

Sometimes the strips of bone graft don't take and end up dissolving. A second surgery may be needed to remove the strips and apply more graft material. The doctor may need to apply additional metal hardware to hold the new grafts firmly in place.

When instrumentation is used, the screws, rods or plates can also cause problems. They can loosen and irritate the nearby soft tissues. In rare cases, they may actually break. If your hardware loosens or breaks, the�surgeon�may suggest another surgery either to take out the hardware or to add more hardware to solve the problem.

Muscle Disruption

During the course of the operation, the surgeon first lifts off the small muscles that run along the back of the spinal column. Some of the nerves going to the muscles are detached. Lifting the muscles away from the bone blocks the blood supply to the muscles. Disruption of the nerve and blood supply can cause the muscles to tire easily, especially during a long work day and with heavy or repeated lifting. Exercises designed by a physical therapist boost strength and endurance in the nearby muscles, reducing symptoms from this problem.

Nonunion

Sometimes the bones do not fuse together as planned. This is called a nonunion or�pseudarthrosis. When more than one level of the spine is fused at one time, there is a greater chance that nonunion will take place. This means that when two or more consecutive discs are removed and replaced with bone graft, pseudarthrosis will occur. If the joint motion from a nonunion causes pain, you might require a second operation.

In the second procedure, the surgeon usually adds more bone graft. Metal plates and screws may also be added to rigidly secure the bones so they will fuse together.

Ongoing Pain

Posterior lumbar fusion is a complicated surgery. The outcome of complete pain relief is also not guaranteed. In more than 80 percent of the cases successful fusion does occur. A solid fusion, though, does not guarantee freedom from pain or the ability to return to normal activity. If your pain persists or becomes worse, talk to your surgeon about treatments that can help control your pain.

The other Orthopedic Procedures are:

• Achilles Tendon Repair
  
• Hip Replacement
  
• Knee Joint Replacement
  
• Disc Hernia�
  
• Elbow Replacement�� etc

Few Major Hospitals for Lumbar Fusion are:

• Wockhardt Hospitals
  
• Apollo Hospitals
  
• Max Healthcare
  
• Piyavate Hospital
  
• Florence Nightingale Hospital
  

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