Anterior Posterior Lumbar Interbody Fusion

What Is An Anterior & Posterior Lumbar Interbody Fusion?

An anterior & posterior lumbar interbody fusion is a procedure that takes place first through the lower abdomen and then through the back. The vascular surgeon assists your surgeon to make a lower abdominal incision and expose the front of the spine. The disc material between two vertebrae is removed and a spacer containing either bone from your pelvis, cadaver, or other biologics, is put in its place, which stimulates bone growth in this area.

The anterior incision is then closed and you are repositioned for the posterior approach. Two small incisions are made on the right and left sides and then dilators are used to expand the surrounding muscle and expose the operative site. Screws and rods are used to stabilize the bones. If needed, any structures, such as bony overgrowth or tissues that are compressing on the nerves are removed. Intraoperative fluoroscopy, or x-ray, is used throughout the procedure to ensure proper placement of the spacer and hardware

When Is An Anterior & Posterior Lumbar Interbody Fusion Necessary?

Anterior & posterior lumbar fusion may be considered in the following situations:

  • Pain worsens when bending forward at the waist
  • Pain increases with physical activity or sitting
  • Nerve pain radiates down the buttock and thigh
  • Chronic low back pain is inhibiting normal activities
  • Conditions that may be treated with this procedure include:
  • Fracture of the lumbar spine
  • Disc degeneration in the lumbar spine
  • Instability or spondylolisthesis of the lumbar spine
  • Post-discectomy syndrome
  • Infection or tumor of the lumbar spine

Spine surgery is typically not the first line of care. Physicians usually prescribe pain-relieving or anti-inflammatory medications and physical therapy as conservative treatments for back pain. Surgery can be highly effective for patients who have not achieved satisfactory results from these modalities.

How Long Is The Anterior & Posterior Lumbar Interbody Fusion Procedure?

Surgical time is determined by the number of vertebrae that are involved in the fusion. Generally, the surgery takes between 5 and 7 hours. After the procedure, patients are transferred to the recovery room for a short time. There, they are monitored until awake and alert. At that time, they can be transferred to their hospital room.

What Are The Benefits Of Anterior & Posterior Lumbar Interbody Fusion?

Fusing both the front and back regions of affected lumbar vertebrae provides several benefits. Primarily, this procedure achieves an incredibly high degree of spinal stability. The size of the lumbar vertebrae creates a large surface area for the optimal fusion of two bones. The two-sided approach can also increase the degree of deformity correction when necessary. Multiple studies have shown that the fusion of anterior and posterior aspects of damaged vertebral sections leads to a high fusion rate (over 95%). While anterior & posterior spinal fusion is more complex than a single directional approach, clinical evidence suggests that patients may regain mobility more quickly when this technique is employed.

How Long Will I Need To Recover After The Surgery?

Patients may stay in the hospital for 1 to 2 nights after their lumbar procedure. This allows the hospital staff to manage post-operative pain using IV medications the first day and then transition to oral pain medication before the patient is released to go home. Prescription pain medication continues at home to maintain comfort as the fusion progresses.

It can take several months for the fusion to be complete. However, patients tend to experience significant pain relief even before bones fuse completely. During recovery, it is important to maintain proper spinal alignment. This may be achieved by wearing some type of back brace that restricts motions like twisting and bending at the waist. The healthcare team at the hospital will assist the patient with learning how to properly stand, sit, and walk.

Once home, patients will increase their level of activity according to comfort. Initially, activity may be limited to walking short distances. This should increase gradually as comfort improves. Walking helps prevent blood clots after surgical procedures so should be done several times a day. At first, this may be around the house only. The surgical team may discuss how to increase walking and other light activities safely based on the unique situation of each patient.

Lumbar fusion can take several months to reach completion. As the bones fuse and muscles around the spine regain strength and flexibility, patients can increase their level of activity and may be able to return to work, depending on the strenuousness of their job.

Will I Need Physical Therapy After Anterior & Posterior Lumbar Interbody Fusion?

Yes. Physical therapy may begin approximately 4 to 6 weeks after the fusion procedure to restore adequate strength and flexibility around the lumbar spine. Physical therapy can expedite the rehabilitation of the spine and potentially enhance the outcome of this pain-relieving procedure.

What Activities Should I Avoid After The Procedure?

During the first few weeks of recovery after the anterior & posterior lumbar fusion, patients may have to limit lifting to no more than 5 pounds. Twisting and bending at the waist should also be avoided for up to 4 weeks to avoid unnecessary strain in the muscles around the lumbar spine. Bending and twisting may resume gradually after 4 to 6 weeks of healing and with physical therapy to increase mobility.

Should I Expect Pain After Anterior & Posterior Lumbar Interbody Fusion?

Minimally invasive spine surgery can achieve significant improvements for the patient with ongoing pain and limited mobility. While the quality of life is typically much higher after anterior & posterior lumbar fusion, patients may continue to experience mild to moderate discomfort at times. That being said, based on patient reports, this procedure has a very high success rate.

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