Fusion, in simple terms, means joining of two bones and in this case between the two blocks of Spinal Working Unit. Lumbar fusion procedure is similar to decompression but is supplemented by screws and rods. The primary aim of the lumbar fusion is to address the exit foramen or the tunnel along the slip road (Read More). Restoration of the tunnel (Keyhole) height is achieved by placing a block or cage after removal of the degenerated disc. The screws and rods work like a scaffolding while the fusion takes place. Once fusion takes place, the whole spine working unit acts like a single block of bone. The cage can be placed in the disc space through different approaches, and based on this, they are either called ALIF/ OLIF (Front), XLIF (Side) and TLIF/PLIF (Back). The majority of the Surgeons would perform these procedures from the back of the spine either via PLIF or TLIF. These different approaches have their own set of advantages and disadvantages and need to be tailored according to the patients need and Surgeon’s skillset. The ultimate goal is to decompress the impinged nerve and to restore the normal anatomy of the spinal working unit.

These procedures are considered to be more complex compared to simple decompression and the associated risks are higher. The risks can also vary according to the approach taken by the Surgeon and your health condition.

In general, these procedures are aimed to address both the leg as well as back pain symptoms. However, it is believed that the chances of improving back pain is slimmer when compared to leg pain. Thus, better understanding of your own condition, symptoms and goal is needed prior to undergoing this extensive surgery.

Post-operatively, early mobilisation and rehabilitation is important, and you will be advised on physiotherapy exercises. I advise patients to take few general precautions, such as not lifting heavy objects especially while bending forward, and not to sit down for prolonged periods of time. Regarding walking, I would suggest not to go for long walks in the first two weeks to avoid sweat collection around the wound. Thereafter, gradually increase your walking distance and activity under the guidance of your physiotherapist.  

Spinal Surgeon

Mr. N K Rath

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