What is it?

A typical patient requiring lumbar fusion surgery usually has a trapped nerve root at the side of the spine (foraminal stenosis) due to one vertebra being slipped forwards on another (spondylolisthesis).

On occasion lumbar spine surgery may involve the use of implants such as cages, screws and rods to stabilise and fuse the spine. This is recommended only in a minority of cases and usually where there is pre-existing spinal instability (spondylolisthesis).

Lumbar fusion is not recommended for non-specific low back pain.

Diagnosis and treatment options

As well as an MRI scan of the lumbar spine, patients undergoing assessment for lumbar fusion may also need:

• Flexion and extension standing lumbar spine X-ray
• Whole spine scoliosis X-ray
• CT scan of the lumbar spine
• DEXA scan to assess bone density

Before lumbar fusion, your surgeon will discuss and recommend non-surgical treatments such as pain relief, physiotherapy and day case steroid injections.

Lumbar fusion is only performed if your symptoms cannot be controlled by other means.

Outcomes and complications

Outcomes for nerve pain are good with 80-90% of patients reporting improvement in symptoms. (Spine Tango data)

Improvement in back pain is less certain and medical literature suggests 50-70% improvement. This is why lumbar fusion is not recommended for non-specific back pain alone.

As with all surgery there is always some risk of complication. These will be discussed prior to going ahead with any procedure. For this type of surgery, risks include:

• Wound infection - 2-3%
• Bleeding - 1%
• Spinal fluid leak - 5%
• Leg pain or back pain worsens - less than 5%
• Implant malposition requiring early revision - 1%
• Delayed fusion failure or adjacent segment disease requiring further surgery
• Rarely nerve injury causing numbness, weakness or paralysis in the legs or problems with bladder, bowel or sexual function - less than 1 in 1000
• Injury to a major blood vessel – 1 in 4000
• Complications associated with general anaesthesia (heart problems, chest complications, blood clots, infection) - these risks may increase with certain medical conditions

Data from Spine Tango.