What is Posterolateral Fusion?
Posterolateral fusion is a type of spinal fusion surgery of the lower back.
This is one method of performing lumbar interbody fusion where the disc space is left intact.
The transverse process, which is the bony protrusion on each side of the vertebra, is exposed where the bone graft or bone substitute is placed for fusion.
Why is it done?
The surgeon may suggest Posterolateral Fusion as a treatment choice depending on various factors such as the patient's spinal condition, age, activity levels, and medical history. It may be recommended for the following spinal instability conditions:
- Degenerative disc disease
- Spondylolisthesis (in which one vertebra slips over another)
- Spinal stenosis
What happens during the Posterolateral fusion procedure?
Before the procedure, the patient will typically undergo a thorough evaluation by the surgeon to determine the underlying cause of their pain and whether a TLIF is an appropriate treatment option. This will also include an anaesthetic assessment for fitness for surgery.
The surgery is usually performed under general anaesthesia, and the patient lies face down on the operating table.
The surgeon makes a small incision in the lower back during a Posterolateral fusion.
The surgeon retracts the muscles on one side to access the bony arch and roof of the spine (lamina). Then, the lamina (roof of the vertebra) is removed to visualise the nerve roots and free them.
The transverse process, which is the bony protrusion on each side of the vertebra, is exposed where the bone graft or bone substitute is placed for fusion. The bone graft stimulates the body to grow new bone tissue, which eventually fuses the vertebrae together, forming a solid bone mass.
Metal rods or screws may be inserted to provide additional support and promote healing.
What happens after the procedure?
After the procedure, the patient is taken to a recovery room, where they are monitored briefly before discharge. Patients can usually return home after safely mobilising following the surgery. Depending on the case's complexity, this may be a day or a few days.
Patients are given pain medications to manage the discomfort. They may also be instructed to avoid bending, lifting, or twisting for several weeks. Patients may need to undergo physical therapy to strengthen their muscles and improve their range of motion. The recovery period varies for each patient, but most patients are off work for initial four weeks. If it’s a strenuous job, then you may be off for up to 8 weeks.
What are the potential side effects of the procedure?
As with any form of surgery, there are risks associated with it.
Possible some list of complications include:
- Nerve damage
- Blood clots
- Bowel or bladder problems
All the risks and benefits will be discussed during the consent process.
The primary risk of Posterolateral Fusion is the failure of vertebral bone and bone graft fusion, which may require additional surgery.
You can reduce the risk of fusion failure by:
- Stop cigarette or tobacco use.
- Eat a healthy and nutritious diet to fuel the body during healing.
- Exercises must be performed during your recovery to enhance the healing process.
Please consult your physician for a complete list of indications, warnings, precautions, adverse effects, clinical results, and other important medical information that pertains to the Posterolateral Fusion procedure.
Please follow the BASS (British Association of Spinal Surgeons) website for more information.
Other surgical interventions that, like Posterolateral Fusion, aim to restore spinal stability, alleviate pain, or correct spinal deformities. Some of these procedures may be performed in conjunction with Posterolateral Fusion or serve as alternative treatment options depending on individual patient needs.
ALIF (Anterior Lumbar Interbody Fusion): ALIF is a surgical procedure aimed at fusing the anterior portion of the lumbar spine to alleviate discogenic pain and restore spinal stability. It's a viable option for patients with certain spinal conditions.
TLIF (Transforaminal Lumbar Interbody Fusion): Like Posterolateral Fusion, TLIF seeks to stabilise the spine and relieve nerve compression, but through a different surgical approach. Explore the nuances of TLIF to better understand your spinal fusion options.
Lumbar Laminectomy: Often performed to alleviate symptoms of spinal stenosis, a Lumbar Laminectomy involves the removal of the back part of a vertebra to create more space within the spinal canal, potentially in conjunction with Posterolateral Fusion for enhanced spinal stability.
Cervical Laminectomy: A surgical procedure that creates more space for the spinal cord and nerve roots in the cervical spine by removing the lamina. Like Posterolateral Fusion, it aims to alleviate symptoms of spinal stenosis and may be performed in tandem for comprehensive spinal decompression and fusion.