Spinal Fusion Surgery
Minimally invasive Endoscopically Assisted Interbody Fusion and Facet Fixation
The surgeons at Spine Institute Northwest specialize in minimally invasive interbody fusion and facet fixation because, when compared to traditional open back surgery, it offers patients:
- Fast Recovery
- Less post operative pain
- Small incision
- Minimal bleeding
- Same day procedure, done outpatient
- Most procedures do not require general anesthesia
What conditions does this procedure aim to treat?
Some of the most common conditions that this surgery aims to treat are: degenerative disc disease, facet joint disease, spinal stenosis, bulging/herniated disc, pinched nerves, bone spurs, sciatica, arthritis of the spine, spondylolisthesis, foraminal stenosis.
How Does Lumbar Interbody Fusion and Facet Fixation Work?
We use the facet screw to stabilize the spine and to make fusion procedures more effective. The facet fixation procedure can provide pain relief for those with a variety of conditions. This procedure helps provide stabilization to the spine when intervertebral disc degenerates and no longer can provide stability and support and/or when facet joint degenerate. When this happens, the adjacent vertebras collapse and the spinal nerves get compressed.
Stabilization of the spine is done by using facet screws and an intervertebral implant. Depending on patient condition, facet fixation can be done on its own or combined with the intervertebral implant.
This procedure cannot make your back as good as new, but we hope to bring significant improvement. It will take between 6 months and 2 years for the bones to fuse together and during this time you will need to be careful to avoid injury. We find that this procedure can improve quality of life and help you feel better while slowly returning to your regular activities. Yet majority of our patients report great satisfaction with this minimally invasive lumbar fusion surgery early post operatively.
Be realistic. Your back will never be as good as new. It is unusual to be totally cured of pain and to not be left with some lumbar pain and/or pain in the buttocks, hips or thighs. The aim of surgery is to get significant improvement in your symptoms.
Low back advice after surgery applies to you as to everybody in the community. The best posture is keeping your low back as vertical as possible, like a column of bricks – e.g. bend your knees to get low to the ground rather than bending your low back. Try to minimize bending (forwards, backwards or sideways) and twisting, especially if you are carrying something. However, (and this sounds contradictory) postoperatively you will be encouraged to try to mobilize your low back so that it does not become stiff at the unoperated levels. Postoperatively you can sit as soon and long as you like, until it becomes uncomfortable. You can drive as soon as you wish but this may be painful and it would be preferable if you were driven by someone else early on.
A light lumbar support may be used postoperatively for additional pain relief. You are encouraged to do away with the brace as soon as possible or only use it intermittently, because you will be encouraged to strengthen and mobilize your trunk (back and abdominal) or core muscles.
There is absolutely no doubt that smoking is associated with lower success rate of fusion. Smoking interferes with the development of new blood vessels that are essential for healing.
Physical therapy is recommended to strengthen your spine. Please talk to your surgeon before staring physical therapy.
Walking is a great exercise. Try to walk as much as possible – e.g. at least one kilometer twice a day.
Straight leg raises
On the day after surgery you will begin straight leg raises (each leg separately for one minute, up as far as tolerable) twice a day for at least six weeks, or until you get your leg up to 90 degrees to your body. Someone should assist you initially. These leg exercises are to diminish postoperative scarring at the site where the sciatic nerve roots in your back have been operated upon.
Trunk muscle strengthening
A simple exercise can be done anytime and anywhere, before and after surgery. Start four times a day by tightening your abdominal muscles for at least 10 seconds, like straining on the toilet, breathing at the same time. The more you do this the better. Swimming (particularly freestyle) is an excellent exercise, puts little stress on your low back and can start once I am happy that your wound has healed (about 1-2 weeks).
Lumbar spine mobilization (movement)
This is to prevent your entire low back from getting stiff. Your fusion is immediately solid due to the facet screws (if present). Back mobilization will be difficult initially because of wound pain and muscle spasm but you will be encouraged to move within the limits of discomfort, commencing as soon as possible after surgery. Twice a day try bending forwards, backwards, right and left sideways, and right and left rotation (twisting), going as far as is comfortable, holding each position for 10 seconds. On the other hand, with everyday activities, you should maintain the principles of low back care, keeping your back vertical and not doing unnecessary lifting, twisting, bending, etc. Initially it will also help if you mobilize in a warm pool (hydrotherapy).
It is arguable if your low back should be manipulated after a fusion, but certainly not until the bone has fully knitted. Please talk to your surgeon before starting chiropractic post operatively.
Long term outcome
You should gradually get back to all your activities of daily living (dressing, showering, driving, etc). Because a portion of your spine has been operated on and stiffened, patients often describe a fullness at the operation site. You should not expect to return to all of your former activities although this is possible, depending on your demands – e.g. a laborer is unwise to return to former heavy work but a casual golfer could gradually return to golf once the bone has fully knitted. In general, low impact activities are encouraged – e.g. walking as opposed to jogging. The aim of surgery is to get you as comfortable as possible and return your quality of life.
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