Posterior Lumbar Fusion (PLF) surgery is a surgical procedure in which the back part of the lumbar spine is fused from the back. This procedure is called a “posterior” lumbar fusion because the surgery is performed from the back (or “posterior” aspect) of the body as opposed to surgeries performed from the front or side of the body.The surgeon makes an incision in the lower back, through the muscles. It is common to perform decompression surgery combined with the PLF. A bone graft is placed along the edges of the back part of the spine. Often, pedicle screws are placed into the vertebral bodies and connected with rods. This helps to stabilize the spine.
Lumbar fusion surgery is performed for a variety of conditions. Broadly speaking, a fusion surgery is required when there is spinal instability, a deformity, or occasionally when the stenosis is very severe. Examples of these conditions include spondylolisthesis (when one vertebrae slips forward relative to the vertebrae below it), spinal deformity, scoliosis, kyphosis, flat back syndrome, stenosis, and in patients with previous spine surgery.
The decision to proceed with surgery must be made in jointly between you and your surgeon. Once you have decided to have surgery, the following events take place:
Pain control is individualized for each patient based on their history, the nature of the surgery, and the reported pain level. Pain medications are meant to help reduce the pain, but are not supposed to completely eliminate pain. In general, patients are given a PCA (patient controlled analgesia) pump to use right after surgery. This allows you to push a button and receive “on demand” intravenous (IV) pain medication. Once you are able to take pills by mouth, you will typically be transitioned over pain pills as these provide longer periods of pain relief than IV pain medication. One side effect of pain medication is constipation. Therefore, it is important to remember to take over-the-counter stool softeners (e.g. Colace, Docusate) and laxatives (e.g. Dulcolax, Senokot, Milk of Magnesia). Do NOT use any NSAIDs, such as aspirin, Advil, Motrin, ibuprofen, Aleve, or naproxen, after your fusion surgery because this can increase your risk of bleeding and interfere with bone healing.
You can typically take a shower 3-5 days after your surgery, but do not take a tub bath or submerge the incision under water until your surgeon says it’s ok. Prior to showering, remove the gauze bandage. Often times, there will either be a purple or clear glue over the incision (aka Dermabond) or white Steri-Strip stickers on top of the incision. Do not scrub, pick at, or remove the Dermabond or Steri-Strips. These will fall off on their own. When showering, it is ok to let water run over the incision. Afterwards, pat the incision dry and apply a new gauze dressing over the incision. Keep your dressing clean and dry. Change the dressing once a day, or more often if it becomes dirty. Wash your hands before and after changing the dressing. Do not apply creams, lotions, or ointments on or near your incision. Check for signs of infection, such as swelling, redness, warmth to the touch, or yellow or green discharge.
You will have a post-operative follow-up appointment with your surgeon a few weeks after surgery to ensure that your wound is healing appropriately, your pain is controlled, and your preoperative symptoms are improving. However, there are times when you should contact your surgeon’s office sooner. If your temperature exceeds 101.5º or if the incision begins to separate or show signs of infection (such as swelling, redness, warmth to the touch, or yellow or green discharge), call your surgeon’s office immediately. Also if you develop new or worsening pain, numbness, weakness, or loss of bowel or bladder control, you should contact your surgeon right away.
Recovery time will vary depending on the number of levels fused, the specific type of surgery you had, your health and physical condition prior to surgery, and a variety of other factors. However, in general, patients are in the hospital for a few days before going home or occasionally to a rehabilitation facility. For the first several weeks, the goal is to take it easy, but you should stay mobile and continue to walk daily. It is important to remember not to lift anything heavier than a gallon of milk, bend or twist through the back, or do any impact activity (e.g. jogging, running, horseback riding, cross-training, etc.) until cleared by your physician. You will start physical therapy once adequate healing has taken place in your back, usually after a month or so. It takes the human body anywhere from 3-6 months in order to fully heal the fusion. Therefore, follow all activity limitations for several months post-operatively until your surgeon tells you that the fusion has fully healed.