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Lumbar Interbody Fusion and Facet Fixation

Do you have back and/or leg pain caused by degenerated discs in your spine?

Minimally invasive lumbar facet fusion performed by surgeons as the Spine Institute Northwest may be the answer.

For patients whose spinal condition requires a fusion, the endoscopically assisted procedure is a safer, less invasive spinal fusion alternative that also provides the surgeon the option to approach the spine from the side (lateral) of the patient rather than the front (anterior) or the back (posterior).

The surgeons at Spine Institute Northwest specialize in minimally invasive interbody fusion and facet fixation because, compared to traditional open back surgery, it offers patients:

  • Less pain
  • Faster recovery
  • Higher rate of success

What Are Facet Joints?

The bones in your spine, called vertebrae, are connected by three joints: a large disc in the front and two small facet joints behind. These facet joints can become worn, leading to neck, shoulder, or arm pain (emanating from the upper back), or pelvis, hip or thigh pain from the lower back. Facet fusion joins vertebra together, like mending a broken bone, allowing you to return to normal activities with a minimum of pain.

Since it avoids cutting and disrupting the muscles of the back, lumbar interbody fusion allows for a less painful surgery with fewer traumas to the body than traditional open fusion surgery. The patient can recover in weeks instead of months required for traditional fusion techniques.

How Does Lumbar Interbody Fusion and Facet Fixation Work?

The procedure uses a specialized facet screw system, designed to stabilize the spine as an aid to fusion (the process by which bones are fused or “knit” together). During this minimally invasive procedure, the spine is approached through small incisions. Under the guidance of x-rays, a dilator is inserted between the abdomen and the spinal muscles. To make sure nerves are not harmed or irritated during the process, neuromonitoring (testing of the nerves) is conducted during the procedure to provide the surgeon with real-time information about the position of the nerves related to his or her instruments.

Implanted facet screws (seen from the back and side)

Once the dilator is precisely positioned, a retractor is put into place so that the surgeon can approach the target disc. With this direct access, the surgeon is able to remove the target disc material, or bone fragments. After the disc material is removed, an implant is inserted through the same lateral incision. A spacer cage is then used to help hold the vertebrae in the proper position to make sure the disc height is correct and the spine is properly aligned. This spacer together with the bone graft will allow the spine to fuse.

Who Needs Interbody Fusion and Facet Fixation?

The facet joints, also sometimes called zygapophyseal joints,  are most commonly affected by osteoarthritis (wear and tear arthritis). Facet joint pain can be felt over the affected joint but can also be referred – to the shoulder girdle, shoulder blade or arm in the case of the neck, or into the bony pelvis, hip or thigh in the case of the low back. It tends to be worse with extension of the spine (bending backwards). Plain x-rays, CT or MRI scans can identify facet joint disease but sometimes the most sensitive test is a nuclear bone scan (see figure), which can identify facet joint problems when the other tests appear less obviously abnormal.
Each patient has different abilities and needs. Therefore, your doctor will determine if you are a candidate for a lumbar facet fusion.

 

What Should I Expect from the Surgery?

Lumbar facet fusion is like fixing a broken bone, aiming to join one vertebra (spinal bone) to another. It takes six months to two years for the bones to knit (fuse). In the meantime, your screws and rods keep the fusion site solid. Your recovery will need supervision with a physiotherapist, plus some common sense, to balance between mobilizing the lumbar (low back) joints that aren’t fused and avoiding placing too much stress on the fusion site until it is fused. It’s important to keep your expectations realistic. Your back will never be as good as new. It is unusual to be totally cured of pain and not be left with some lumbar pain and/or pain in the buttocks, hips or thighs. Instead, the aim of surgery is to get significant improvement in your symptoms.

What Are Post-Operative Indications?
Posture

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. Though it may sound 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.

Brace

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 (0-3 weeks), or only use it intermittently, because you will be encouraged to strengthen and mobilize your trunk (back and abdominal) or core muscles.

Smoking

There is absolutely no doubt that smoking reduces the success rate of fusion. Smoking interferes with the development of new blood vessels that are essential for developing new bone.

Physical therapy

Your physiotherapist will supervise you postoperatively and will make sure that your care continues after discharge with a physiotherapist convenient to you. PLEASE DISCUSS WITH YOUR SURGEON WHEN YOU CAN START PHYSICAL THERAPY AFTER YOUR OPERATION. DO NOT BEGIN OR RE-START ANY TYPE OF THERAPY BEFORE DISCUSSING IT WITH YOUR SURGEON.

Walking

Walking is a great exercise. Once you are back home and especially after your sutures are removed, try to walk as much as possible — at least a half a mile 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), and you will continue to perform these 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

To strengthen your trunk, 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 your physician is happy that your wound has healed (about 1-2 weeks).

Manipulation

It is arguable if your low back should be manipulated after a fusion, but certainly not until the bone has fully knitted.

What is My Long-Term Prognosis?

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 (think 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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