Back Pain Balloon kyphoplasty Cervical plating Lumbar Fixation Lumbar Microdiscectomy Scoliosis Spinal Stenosis:Lumbar & Cervical Spondylolisthesis Send Your Query Lumbar Fixation by Dr.Shankar Acharya Introduction Lumbar body fixation is a technique where we fix up two or more vertebrae through rods and pedicle screws so as to give stability to the spine. The main purpose for fixing up the spine through rods, plates and screws is to provide stability to highly mobile segment. Fixation is essential in patients with chronic backache as it makes the spine rigid and thus pain level decreases as spine becomes stable. Normal Lumbar Spine Anatomy Lumbar column is made up of 5 lumbar vertebrae. As it takes the maximum weight and is the most mobile segment of the vertebral column, it is more common to undergo degeneration i.e. age related wear and tear. How will I be benefited out of the surgery? • It will help relieve the back pain and leg pain and hence set you pain free. • It will make the spine rigid and fixed and hence functionally stable. • Maintains the proper balance and curvature of the spine. • Quicker return to daily activities and work. Patient can get up and walk next day itself. How is the surgery performed? It is a mini open surgery usually done through a incision or multiple in the back. The incision size depends upon the number of bones to be stabilized. The muscles are cut and retracted so as to reach to the bony spine. The motion segments that are to be stabilized, is fixed through pedicle screws inserted in each vertebrae and then are connected through vertical rods through the screws. This way the spine is made to be stable and rigid. In case of long fixations an interconnecting transverse rod is also used. FREQUENTLY ASKED QUESTIONS Am I a candidate for surgery? Yes, you are a candidate for surgery if you have a severe backache and/or neurological weakness. Is it necessary to undergo the surgery immediately? Immediate spine surgery is only necessary in cases of : 1. Severe pain in the back. 2. Weakness of legs 3. Bowel/Bladder problems. However, ideally the spine should be fixed as and when your doctor approves for the same depending upon the pain level, your general condition and underlying pathology. Is there any contra-indication of surgery? • Severe osteoporosis • A pregnant female • Any blood clotting disorder • Many co-morbid conditions (Kidney, Heart, Diabetes where risks are more What are the Risks and Complications of the procedure? Generally it is a very safe procedure but some complication may occur due to anesthesia and the surgery which are : • Pain, chest complication, nausea and vomiting due to the side effect of anesthesia. • Infection may occur as a complication. • Bleeding may occur from the incision site. • Wound dehiscence. • Dural tear may occur leading to CSF leakage. • Bowel/bladder injury or injury to soft- tissues may occur. • Nerve root damage. • Screw misplacement or breakage may occur while the procedure. • Paralysis / death are rare complications. However, the above complications for fixation spine surgery are quite rarely seen in only 1-2% cases. Will I be permanently cured by this surgery? Due to fixing up of the involved vertebral motion segment, movement is restricted at the same level. This leads to compensatory increased movements at the level above the fused segment of spine, thus causing increased chances of degeneration of the adjacent segment which may cause backache. Will it relief my pain immediately? Yes, the pain that was coming to your leg would go almost immediately after the compression is relieved but your back pain may take few days to go off completely. Do I need to perform any test prior to surgery? Yes, there are a set of test known as PAC (Pre Anesthetic check up) that you are required to undergo before surgery so as to be declared FIT for surgery by the anesthesia team. How much incision will be left after surgery? It is an open surgery. Usually two-three inches incisions are made at the back of the patient depending upon the level(s) of fixation / for key hole surgery you may have multiple small in incisions. How much time is required for surgery? It takes around 1-3 hours or more to perform the surgery. How much will be the cost of the surgery? Usually the surgery will cost from 1.5 lakhs to 3 lakhs depending upon the level(s) of fixation and implants used, depending upon the room you are the planning to take in the hospital. Does this procedure come under Insurance policy? Yes, for undergoing lumbar fixation, you can have your insurance cover. You can confirm the same once with our Admission desk/ TPA desk. You can take along your insurance card and policy. Will the surgery be performed under local or general anesthesia? This procedure is generally done under general anesthesia. What is the success rate of the surgery? The success rate for lumbar spinal fixation ranges from 70 percent to over 90 percent, depending upon the procedure, level(s) fixation and patients’ general health condition. Is there any alternative to the surgery? Yes, either you live with your backache and continue taking medicines and/or physiotherapy. What are the restrictions that I need to take following surgery? • Restriction from bending, lifting, or twisting for the first six weeks following surgery. • Proper wound care; keep the wound dry and clean till the suture removal. • Advised not to lift heavy objects for 12 weeks following the surgery. • You have to wear a lumbo sacral belt for 6-8 weeks. When do I have to come back post surgery? Usually you have to come after 2 weeks post surgery for stitch removal and then at 4 weeks interval and/or as advised by your Doctor. Can I have bath after going back home? No not till the stitch removal. Can I drive after surgery? Patients should not drive until they are given approval by their doctor. Normally you can drive 4-wheeler after 1 month of surgery. Two wheelers need to be avoided. Do I need Post operative Rehabilitation or therapy? Yes you need to under go physical therapy under a trained physical therapist initially. The therapist will make you- • Perform the activities of daily living, for ex. lying to sitting; to stand. • General conditioning exercises. • Deep breathing exercises. • Gentle stretching exercises. • Understand the proper postural stability. When can I undergo the surgery? When you are mentally prepared for surgery, you can call and confirm the same to our team on the following numbers, so as to book the operation theatre and room for you- You will be provided the tentative date for admission and surgery.