Lumbar Fusion Rehabilitation

Indications

-Severe, disabling back or leg pain.

-Posttraumatic cases of segmental instability or potential neurologic injury

-Degenerative spinal pathology with failure of conservative treatment.

Degenerative cascade

Degenerative Disc Disease

Diagnosis:

Spinal radiographs showing:

-Osteophytes and segmental disc space narrowing in patients with degenerative spondylosis.

-A defect in the pars interarticularis

-Anterolisthesis, or a forward slippage of one vertebra on the next, is the hallmark radiographic finding in spondylolisthesis.

- Flexion and extension films can help to detect hypermobility or excessive motion in degenerative lumbar conditions

Types of lumbar fusion:

• The goal of a lumbar arthrodesis is the successful union of two or more vertebra
• Instrumentation can be used to immobilize the moving segments while the fusion becomes solid.
• Today, most spine surgeons use pedicle screw constructs to immobilize the vertebrae rigidly while preserving the normal lumbar lordosis 2

Posterolateral Lumbar Fusion:

-A midline posterior incision, with a laminectomy if necessary. -Transverse process, pars interarticularis, and if needed, the sacral alae are decorticated (posterior fusion). then a bone graft is placed on the decorticated surfaces.

Pedicle screws and rods or plates may be placed to immobilize the motion segments rigidly and augment the formation of a solid union.

- In routine cases of posterolateral fusions the disc is not radically resected. Biomechanical studies have shown that people bear load through the middle and posterior thirds of the disc. Several reports describe a persistently painful disc under a solid posterior fusion.14

Interbody Fusion:

A-posterior lumbar fusion (PLIF)

-Associated with a higher incidence of postsurgical nerve injuries.

D-Lateral Interbody Fusion

-Nerve stretch injury reported, with L4 nerve root injury most common.17

E-Interbody Cages

-Hollow cylinders made of titanium, carbon ,or bone filled with autogenous bone graft or a bone graft substitute and inserted between the vertebral bodies.