Thousands of people suffer from lower back pain, and spinal surgery is a viable option for many. For some of these sufferers, anterior lumbar interbody fusion surgery, in which a bone graft is added to part of the spine to prevent movement, can help relieve the pain. The risks and benefits should be weighed carefully before undergoing a surgery as invasive as an anterior lumbar interbody fusion. There are possible alternative treatments and therapies that may produce better results when considered on an individual basis.
An anterior lumbar interbody fusion differs from some other types of spinal surgery in that it involves approaching the spine through the front of the body. The lumbar of the spine consists of the last five vertebrae, called the L1 through the L5. The term "interbody" refers to the material that will be used between the vertebrae as a substitute for a damaged disc. Fusion is the organic process of the bone grafts adhering to the vertebral body.
The most common diagnoses that may require anterior lumbar interbody fusion are degenerative disc disease, spondylosis, tumors, or infection. When the bone in the vertebral body rubs against another vertebra, the sciatic nerve is often pinched. This can produce radiating leg pain that hinders many normal activities and can become unbearable.
The spinal fusion surgery procedure is lengthy, and begins with an incision to the abdomen. The layers of skin are cut through and organs moved to the side until the lumbar region of the spine can be viewed. A discectomy is usually needed. A portion of the spinal disc is removed and any bone spurs that may be pinching nerves are sheared away.
Next, a bone from a cadaver, usually a tibia or femur portion, is inserted into the damaged disc cavity. This helps ensure that the collapsed portion of the vertebrae is expanded, and the vertebrae are not resting together to produce pain. The surgeon performing the procedure may opt to expand the spine before inserting the new bone and people have been known to grow in height from the procedure. Cages, screws, rods, or plates are then placed over and into the vertebral column to immobilize the healing bone and facilitate the fusion.
There are several benefits of the spinal surgery. The absence of pain and the return to normal activities are an excellent incentive for many people. Further damage to discs and the spinal column that could result in more pain, paralysis, or deformity can also often be prevented.
Risks are present as well. A large factor to consider is that major blood vessels to the legs surround the surgery area. If these arteries are cut during surgery, it could result in excessive bleeding.
Neurological damage may occur and even paralysis in the lower limbs has been known to happen, although rarely. Additional surgeries are sometimes needed. The recovery time is lengthy and range of motion may be very limited. As with all surgeries, infection and death may occur.
Alternatives exist to anterior lumbar interbody fusion. Physical therapy and pain management for at least six months prior to the surgery is routinely recommended by physicians. A lateral or side operation is less invasive; this type of surgery uses the same techniques as the anterior fusion, but goes through the side, thereby limiting incisions. The time under the knife can be significantly reduced and the recovery is usually much quicker. As with any type of surgery, getting a second opinion and finding a well qualified physician are key factors to success.
