Minimally Invasive Lumbar Fusion
Case Example
Patient is 52 yr. old male with chronic severe low back pain that has failed to respond to conservative (non-operative treatment), including medications, therapy, and injections.
On the lateral (side) view of the pre-op MRI, note the normal appearing discs between L1 and L4, marked with white asterisk. The discs between L4 and S1, marked by the dark arrowhead, are not normal appearing. While the disc at L5-S1 is clearly flattened, the disc at L4-5 has a bulge at the back and does not have the same white signal as the normal discs above.
The decision was made to include the L4-5 disc in the fusion since, after fusing L5-S1, the stress would be concentrated on the next level, which in this case, already shows signs of wear and tear.
One month after surgery, the interbody spacers, which are invisible to xray except for the metal markers in them, can be seen in the interspaces between the vertebral bodies.
The patient's back pain was significantly better by about 6 weeks. Seven months after surgery, the patient is feeling much better. On the lateral (side) view, some calcification (whiteness) can be seen in the interspaces. This finding, however, is subtle.
By checking the patient with a CT scan, however, the bony healing between the vertebral bodies can be demonstrated on the reconstructed views.
The patient was released to his regular duty at 8 months post op. However, since he has two less discs in his spine (four discs doing the job of six), he is still advised to avoid frequent bending, lifting, and twisting.
On the lateral X-ray at one year post op, more calcification can be seen between the vertebral bodies as indicated by the asterisk.
The patient continues to do well.
Here's another example of a patient who at one year after a two level fusion had a solid bony connection.
But this fusion doesn't occur in every case.
And in this case, although the patient has no leg pain (a symptom you might expect with pressure on the nerve), extra bone grew very near the foramen, which is the hole through which each nerve root exits the spinal canal.