Lumbar Fusion Rehabilitation

Indications

-Severe, disabling back or leg pain. -Posttraumatic cases of segmental instability or potential neurologic injury -Degenerative spinal pathology.

• Patients who cannot manage their pain with conservative measures and have demonstrable, concordant pathology on diagnostic testing may benefit from lumbar arthrodesis.

Diagnosis:

• Spinal radiographs showing:

 - Osteophytes and segmental disc space narrowing in patients with degenerative spondylosis.
 -A defect in the pars interarticularis is seen in patients with spondylolysis. 
 -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.

• Computed tomography (CT) reliably evaluates the bone or spondylosis compression against the nerves.
• Confirmatory diagnostic testing often includes MRI scanning and discography for equivocal cases.

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/laminotomy if necessary.
-Transverse processes, pars interarticularis, and, if needed, the sacral alae are decorticated (posterolateral 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 Interbody Fusion (PLIF)
-Associated with a higher incidence of postsurgical nerve injuries.
 B-Transforaminal Lumbar Interbody Fusion.
C-Anterior Lumbar Interbody Fusion
D-Lateral Interbody Fusion.╇
- Nerve stretch injury reported, the most common is an L4 nerve root injury.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.