360° Fusion (Anterior and Posterior)
360-degree lumbar fusion is also known as an Anterior/Posterior Lumbar fusion. The procedure is an extremely common method for fusing the lumbar spine in which there is an incision anterior in the abdominal area and incisions posterior in the lumbar or low back region. The goal of the procedure is to stop abnormal motion at the involved level of the spine which is producing the pain symptoms. Using the 360 technique for fusion limits the muscle dissection in the low back compared to other procedures such as the trans-lumbar interbody fusion procedure and thereby is less invasive.
There are a wide variety of methods to fuse the lumbar spine with 360-degree fusion considered one of the more successful methods. The risks of the procedure are minimal when using an experienced access surgeon and spine surgeon. The procedure itself inserts an interbody cage between the vertebra that is filled with synthetic bone graft. This is combined with minimally invasive posterior incisions (usually less than an inch or two in length) to perform a posterior fusion with screws to hold the spine in place.
Typically the procedure requires two surgeons to perform – one who is an “anterior access” surgeon and the other who is a spinal surgeon. In many cases, the spine is actually closer to the abdomen than it is to the back due to the thickness of the muscle. As a result, most surgeries require an access surgeon who is responsible for safely maneuvering into the abdomen and exposing the spine. The fusion rates of 360 fusion are the highest of any method to fuse the spine.
- Chronic low back pain around the beltline
- Nerve pain radiating into the buttock or thigh region
- Pain increasing with sitting and/or physical activity
- Worsening of pain with bending forward
What to Expect
Once you have decided to have surgery, the following events take place:
- A medical examination.
- Chest X-ray, EKG, and blood work.
- You may be asked to have a neurological or psychological examination.
- If taking aspirin or anti-inflammatory medications daily, stop these medications at least one week before surgery.
- If you take prescription medications or other drugs, including herbals, ask your doctor how soon before fusion surgery you should stop taking these.
- Do not have anything to eat or drink for 6 to 8 hours before surgery.
- You will check into the hospital the morning of fusion surgery.
- Prior to surgery, you will be asked to sign permits for surgery, anesthesia, blood, and blood products.
- An incision is made by a general surgeon in the abdomen to expose the front part of the spine.
- Fluoroscopy (live X-ray) is used to determine the correct level(s) to be operated on.
- The disc is approached after carefully separating away from the abdominal contents and major blood vessels are moved off to the side.
- The disc is removed.
- A fusion cage or wedge of bone is placed in the disc space.
- Normal compression of the spine will hold the bone or cage in place. A screw may be placed into the vertebrae to act as additional support.
- After the anterior fusion is completed and the incision closed and bandaged, you will be gently rolled over on the operating room table and prepared for the posterior lumbar fusion.
- An incision is made in the low back area.
- Fluoroscopy is used to determine the correct level(s) to be operated on.
- Bone graft is placed along both sides of the back part of the spine.
- Pedicle screws may be placed in the vertebrae above and below the level to be fused.
- The screws are connected with rods.
- The surgery takes approximately 2-5 hours.
- You will be in the recovery room for 1 to 1½ hours.
- The surgeon will contact your family while you are in recovery.
- After going to a hospital room, you will be able to use a PCA pump to get medication for pain control. This machine controls the amount of medication that can be received.
- Staff will usually get you out of bed shortly after surgery.
- The hospital stay is usually 2-3 days.
- A brace or corset is prescribed to restrict bending and promote healing of the fused area.
- You will be given any needed prescriptions and discharge instructions.
- A set of exercises that you can do at home will be provided.
- You will be able to ride in a car or plane upon leaving the hospital.
- It is important to avoid twisting and bending backward.
- Physical therapy is usually initiated after the first office visit with your doctor following surgery.
- Recovery from 360° fusion surgery varies greatly among patients and is dependent on the extent of the surgery as well as the age and health of the individual. Return to work also varies greatly among patients and is related to overall health and the type of work you do. It is important to note that back pain is seldom completely eliminated – the objective with fusion surgery is to reduce pain.
Frequently Asked Questions
Most patients can return to a light-duty job within the first 3-4 weeks. No significant lifting for the first 2 months.
Depending on the diagnosis, patients experience between 60-80% relief of their pain symptoms, sometimes even more.
As with any surgery, there are risks. Stroke/heart attack/blood clot to the lung is the most serious risks, however, these are EXTREMELY LOW risks. Bleeding and infection are the most common less serious risks and these too are VERY LOW risks. Less than 1/1000 patients could have a minor complication.
After the first 2-3 weeks your doctor will release you for sexual activity. Men have a 1% chance of having sexual issues after this procedure.
Typically 90-95% of patients will have significant improvement with the surgery. A small percentage of patients simply will not improve due to not fusing and/or chronic pain issues.
With modern bone graft substitutes, fusion rates are greater than 95%.
The hardware is mostly titanium, therefore it will not set off metal detectors
Determining whether or not the patient requires 360 Fusion is often done using an:
- MRI of the lumbar spine
- CT scan of the lumbar spine
Non-operative Treatments for a 360° Fusion include:
- Physical therapy
- Pain medications/NSAIDs/Muscle relaxers
- Steroid injections and facet joint ablation procedures
Conditions that are often treated using 360 Degree Fusion include:
- Degenerative disc disease of the lumbar spine
- Instability or spondylolisthesis of the lumbar spine
- Fracture of the lumbar spine
- Tumor or Infection of the lumbar spine
- Post-discectomy syndrome