Anterior Lumbar Interbody Fusion

You will need a complete physical exam to be sure you are in good health. A blood test, electrocardiogram (EKG), and chest X-ray need to be performed. Discuss all medications (prescription, over-the-counter, and herbal supplements) you are taking with your health care provider. Some medications need to be continued or stopped the day of surgery.

Medications that thin the blood should be stopped prior to surgery. Your Internist or primary doctor should be consulted prior to changing or discontinuing any medications. Also, stop drinking alcohol 1 week before and 2 weeks after surgery because these activities can cause bleeding problems. An important thing you can do to ensure the success of your spinal surgery is to quit smoking. This includes cigarettes, cigars, pipes, chewing tobacco, and smokeless tobacco. Nicotine prevents bone growth and puts you at higher risk for a failed fusion.

Morning of surgery
• Shower using antibacterial soap. Dress in freshly washed, loose-fitting clothing.
• Wear flat-heeled shoes with closed backs.
• If you have instructions to take regular medication the morning of surgery, do so with small sips of water.
• Remove make-up, hairpins, contacts, body piercings, nail polish, etc.
• Leave all valuables and jewelry at home (including wedding bands).
• Bring a list of medications (prescriptions, over-the-counter, and herbal supplements) with dosages and the times of day usually taken.
• If you have a cold, fever or some other illness the day before surgery, please call your surgeons office.
• Bring a list of allergies to medication or foods.

Under general anesthesia, the surgeon makes an incision roughly 3-4 inches long to allow access to the spine. The surgeon removes most of the disc, taking care not to go too deep, yet decompressing any pinched nerves. Next, the disc space is stabilized by placing a structural bone graft or bone packed cage device into the disc space. The cage is typically made of metal alloy, carbon fiber or polymer. For fusion to occur between two vertebrae, a bone graft is needed to serve as a bridge. Lastly, the bone graft and vertebrae must be immobilized while the bone graft and bed heals and fuses. The fusion area is often immobilized and held together with metal plates and screws. The surgeon closes the incision and you are taken to recovery.

The surgery typically takes 1-2 hours depending upon number of discs involved and has added time for anesthesia and placement of neuromonitoring equipment. Sutures are buried under the skin and dissolve on their own.

The patient normally stays in the hospital from 1-2 days. The specific time of stay in the hospital depends on the patient and the surgeon’s specific post-operative treatment plan. It also depends upon the number of discs involved and the overall size of the operation. The patient is normally up and walking in the hospital by the end of the day of or early the first day after the surgery. Your surgeon will have a specific post-operative recovery and exercise plan to help you return to normal life as soon as possible.

After surgery, minor discomfort from your incision is common but temporary. This can be relieved with mild pain medication. Following the procedure, you may experience persistent numbness, weakness and pain along the path of the nerve that was decompressed, but these symptoms are generally temporary and gradually go away. Patients are instructed to avoid bending and twisting of the back and heavy lifting during the first several weeks. Patients may begin driving when the pain has decreased to a mild level and mobility of the back has improved, which varies between patients. Patients need to be able to turn their back and body enough to see right and left while driving. You may not drive or operate machinery while on narcotic pain medication. Patients may return to sedentary work duties as early as 4-6 weeks after surgery, depending on your surgeon’s recommendation.

The wound area can be left open to air. No bandages are required other than to protect clothing from any remaining wound drainage. Drainage typically stops within the first day or so after surgery. Steri-Strips affixing the suture should be left in place. The area should be kept clean and dry. Showering may begin the day after surgery. Tub bathing, saunas and other environments that place the incision in a moist or wet environment for any length of time should be avoided until the incision heals.

Physical therapy is typically started 2 weeks after surgery. Restrictions are gradually lifted over the 3-6 months following surgery. Maximum medical improvement usually occurs 6-7 months after surgery, although you will usually need additional visits past that time frame to obtain Xrays to assess the implants and the fusion.

For patients with disabling back pain and leg pain significant benefits can be obtained with a successful spinal fusion. Operating through the front of the spine allows the surgeon to avoid disruption of the posterior low back muscles. One should expect the pain to gradually decrease over the first few months after surgery. After that, some additional marginal gains can be seen for several months.