Lumbar Decompression and Fusion

Lumbar decompression and fusion is a two-part surgical procedure designed to relieve pressure on the lumbar spinal nerves and stabilize the affected portion of the lumbar spine.

1. Lumbar Decompression: The decompression portion of the surgery removes structures that are compressing the spinal nerves, such as herniated disc material, bone spurs, or thickened ligaments. This is often performed through procedures such as a laminectomy, in which the lamina (a portion of the vertebra overlying the spinal canal) is removed, or a laminotomy/foraminotomy, in which a small portion of the lamina and/or facet joint is removed to access the disc space or foramen.
2. Spinal Fusion: Once decompression is complete, Dr. Boden stabilizes the spine by fusing two or more vertebrae together using bone grafts, screws, and rods. Some fusions will also include metal cages filled with bone graft, to achieve interbody fusion in addition to the typical posterior fusion. Over time, the fused bones grow together, reducing movement at the affected segment and preventing further instability or pain.

Depending on the severity of the condition and the patient’s health, this surgery can be performed using a minimally invasive approach or a more traditional open surgical technique.

This procedure is primarily used to treat conditions that cause spinal nerve compression and instability in the lower back, including:

• Spinal Stenosis: Narrowing of the spinal canal that compresses the nerves, leading to pain, numbness, or weakness in the legs.
• Recurrent Herniated Discs: When the soft inner material of a spinal disc pushes through its outer layer, pressing on nearby nerves and causing pain, sciatica, or weakness. Typically, the initial surgery for herniated discs is a microdiscectomy, but some patients have recurrent disc herniations that require fusion
• Spondylolisthesis: A condition in which one vertebra slips forward over the one below it, leading to instability and nerve compression.
• Degenerative Disc Disease: Wear-and-tear of the spinal discs, which can lead to chronic pain and reduced mobility.
• Spinal Fractures or Trauma: Fractures or injuries that destabilize the spine, requiring surgical stabilization.
• Failed Back Surgery Syndrome: A condition in which a previous spinal surgery did not provide expected pain relief or functional improvement. When nerve compression is still present lumbar decompression and fusion may be recommended.

Dr. Boden may recommend lumbar decompression and fusion when conservative treatments such as physical therapy, medications, epidural steroid injections, or activity modification fail to provide relief. Surgery is generally considered in the following situations:

• Severe and Persistent Pain: Chronic lower back pain and leg pain that significantly affects daily life.
• Neurological Symptoms: Numbness, weakness, or loss of bowel and bladder control (a sign of cauda equina syndrome) that requires urgent surgical intervention.
• Spinal Instability: If the spine is unstable due to degenerative conditions, fractures, or spondylolisthesis.
• Impairment in Mobility: Difficulty walking or performing daily activities due to nerve compression or instability.

Not every patient with lower back pain needs surgery. Ideal candidates for lumbar decompression and fusion typically include:

• Individuals with clear structural problems on imaging (such as MRI or CT scans) that correlate with their symptoms.
• Patients who have tried and failed non-surgical treatments for at least several weeks to months.
• Those with severe nerve compression leading to progressive weakness or loss of function.
• Patients with spinal instability that causes ongoing pain or dysfunction.
• Individuals in good overall health without significant medical conditions that would increase surgical risks.

Dr. Boden carefully evaluates each patient’s symptoms, medical history, and imaging results to determine whether surgery is the best option.

Recovery from lumbar decompression and fusion varies depending on the patient’s health, the severity of the condition, and whether a minimally invasive or open surgical approach was used. Many patients will feel some relief of symptoms shortly after surgery, but the healing process often takes 6-12 weeks and full recovery can take 6-12 months, with continued improvement in pain and function. Patients are instructed to avoid heavy lifting, bending, and twisting for the first six weeks after surgery to allow the soft tissues and bones to heal. The fusion process typically takes a few months, but patients begin to return to normal activity levels starting six weeks after surgery.