Information for patients about spine surgery

Table of Contents

1. Introduction
2. What is lumbar spinal fusion and decompression?
3. How can lumbar spinal fusion and decompression help?
4. How is lumbar spinal fusion and decompression performed?
5. What are the risks associated with lumbar spinal fusion and decompression?
6. Factors that may negatively affect recovery after surgery and bone fusion

Introduction

The Spinal Surgery Department of AKFA Medline University Hospital provides general information about the procedure called lumbar spinal fusion (vertebral fusion) and decompression. Your neurosurgeon will discuss your specific surgery in detail. This information is intended for patients, their families, or caregivers who may be offered this surgery. This information does not replace a consultation with a physician. If you have any questions, please feel free to contact the professional providing your care. If you decide to have back surgery at AKFA Medline University Hospital, this page provides an overview and general guidance on preparation and hospital discharge. Your surgery requires a short hospital stay: most patients are discharged within 48–72 hours after surgery.

What do you need to do to prepare for surgery?
If you already have conditions such as high blood pressure or diabetes, you should consult your treating physician to prepare thoroughly for the procedure. Make sure to prepare your living environment so that it is comfortable to be at home during the postoperative period.

For example:

1. Arrange for someone to drive you home upon discharge;
2. Ensure you have purchased sufficient food supplies for when you return;
3. Tidy your home so you don’t need to do household chores upon returning;

Ensure you have basic pain relief at home, such as paracetamol.

What is lumbar spinal fusion and decompression?

Lumbar spinal fusion and decompression is the surgical removal of parts of the lower spinal bone—the spinous processes and vertebral arches. The procedure is used to relieve nerve roots where they emerge from the spine, in areas where they have become compressed. Spinal fusion is performed to prevent instability at the spinal level believed to be the source of your symptoms. In some patients, this is caused by a structural condition called spondylolysis or spondylolisthesis. In others, the issue is due to degenerative changes in the discs or joints.

Disc and joint degeneration is part of normal aging, but for some people this process is painful. If you have low back pain, you may experience leg symptoms such as pain or heaviness in the lower limbs. Leg symptoms are caused by movement in the spine that irritates nerves exiting at the level where degeneration occurs. These nerves carry signals to the brain. Even though the problem originates from the spine, pain occurs in the legs because these nerves supply that area.

If neuropathic leg pain is the predominant symptom before surgery, it may take several months to resolve. Postoperative back pain may continue for up to one year.

Over time, spinal symptoms may resolve naturally as the intervertebral disc gradually becomes rigid and limits movement. However, this is a very slow process that can take years. The goal of surgery is to accelerate this process by fusing vertebrae together with a bone graft, thereby preventing pathological movement of the spine and improving your comfort.

How can lumbar spinal fusion and decompression help?

The primary goal is to reduce leg pain (radiculopathy) caused by compression of spinal nerve roots. While back pain may also be reduced, this is not always guaranteed. This surgery relieves narrowing (stenosis) of the lumbar spine caused by age-related changes. Intervertebral discs may dry, collapse, and facet joints may wear down.

Your symptoms may include:

1. Pain in the lower back, buttocks, and legs
2. Sensory changes in the legs such as numbness, tingling, and cramping with walking
3. Some patients may develop leg weakness or bladder issues

Lumbar decompression can relieve these symptoms.

How is lumbar spinal fusion and decompression performed?

We perform this surgery under general anesthesia, which takes approximately 3–5 hours. An incision is made in the lower back, and a retractor gently spreads back muscles to access the spine.

Under X-ray guidance, we insert screws into the vertebral bones. Then we partially or completely remove the intervertebral disc.

Your own bone (obtained during surgery from the vertebra, when placing metal implants) is inserted into the space left after removing the disc, between the bones. Then we connect the screws together with rods to provide rigidity to that area.

At the end of the operation, we may place a wound drain under the skin to remove blood and allow the wound to heal. The drain is a thin plastic tube, stitched to your skin and connected to a plastic bottle. You can walk with the drain, which we usually remove the next day. Over the next few months, the bone within the frame will fuse, forming a bridge between the two bones. This will connect or fuse the vertebrae together, preventing further irritation of the nerves.

What are the risks associated with lumbar spinal fusion and decompression?

Surgery may reduce pressure on the nerves but cannot reverse the effects of degenerative changes that may have occurred over many years. Back pain caused by these changes may not go away after decompression. All surgeries carry risks, and your surgeon will explain the benefits and risks of this surgery in detail. This procedure is performed under general anesthesia, and your anesthetist will explain the risks associated with anesthesia.

Female patients must inform their anesthetist and surgeon if they are or may be pregnant. Anesthetic drugs and X-rays used during the procedure may be harmful to unborn children.

Problems that may occur during surgery:

Nerve damage is rare (risk 1–2%) but can lead to temporary or permanent leg paralysis, loss of sensation, bladder, bowel or sexual dysfunction, and increased pain.

Implant-related issues, including misplacement or loosening. Up to 2% of fusion patients may need a second surgery to remove or revise implants. Sometimes the covering around nerve roots (dura mater) may tear, causing leakage of cerebrospinal fluid. This can be repaired during surgery. However, you may need to stay in bed longer to allow healing and prevent leakage. Rarely, another operation is required to fix the problem.

Problems that may occur later:

Bleeding in the area after surgery is rare but may compress the nerve roots. This can lead to acute leg weakness, pain, and loss of bladder and bowel control. This condition is called "cauda equina syndrome" and may require urgent surgery to remove the blood clot. Nurses will monitor you closely during the first 24 hours after surgery to detect this early.

Other complications may include:

1. Spinal instability or "slippage," requiring further treatment
2. Wound infection, treatable with antibiotics. However, deep infections can be difficult to treat
3. Scarring around nerve roots
4. Chronic pain that may require referral to a pain specialist
5. Degenerative changes at levels above or below the decompressed area may occur later and require additional surgery
6. Failure of vertebral bones to fuse properly

Rare but serious risks include:

1. Risk of vision problems / blindness (rare, 1 in 5000)
2. Risk of heart attack, chest infection, or anesthesia-related problems, including death — reported as 1 in 250,000 cases involving general anesthesia

Factors that can negatively affect recovery and bone fusion:

1. Obesity
2. Smoking
3. Osteoporosis
4. Diabetes or chronic illness
5. Poor nutrition
6. Long-term steroid use

Patients should make every effort to stop smoking to ensure optimal bone fusion and the best possible outcome from surgery