Posterior Lumbar Interbody Fusion

At times nerve pain is related not just to narrowing of the spinal canal but also to instability and movement at a specific level in the spine. In this case a form of fusion is required and the posterior interbody fusion is a workhorse operation for this condition that is done from the back. A modest incision and several days in hospital are needed.

In the operating theatre, mobile X-ray is used to identify the correct spinal level and a modest incision is made on the back. In this case the spinal canal and nerves are fully revealed and protected so that cartilage disc can be removed and a spacer inserted into the disc space, in front of the nerves. Bone that is removed during the initial part of the procedure is processed to form bone graft and then is also placed in the disc space alongside the spacer. Bone screws are inserted and connected by rods to stabilise that level. X-ray is used again to check that the screws are well placed. Over time the bone graft leads to fusion of the vertebrae, providing ultimate stability.

This procedure is moderately painful afterwards and strong painkillers are used, as well as local anaesthetic that is placed in the wound during closure. Walking from the first day after surgery is supported by the physiotherapy team and graduated as pain permits. Time in hospital is several days and from there some people go home if there is enough support, others may spend a short time in a rehabilitation hospital near their home. Arrangements for transfer by ambulance are made during the hospital stay.