Indications: Conditions commonly treated by lumbar fusion include degenerative disc disease, abnormal slippage and motion of the vertebrae, vertebral fracture and other degenerative conditions.

The Procedure

The incision for a posterior lumbar fusion is made through the back. The incision is vertical. The length of the incision is dependent on the number of vertebrae involved. Once the incision is made, the spine is then exposed. Any bone or disc material compressing a nerve
will be removed at this time if discussed prior to surgery. Next a screw is placed on either side of each vertebra involved. The screws are then connected by a rod on each side. Bone graft is then taken from your pelvis and placed alongside the hardware to promote fusion. Bone graft substitute may also be used. (see diagram)

A screw is then placed on either side of each vertebra involved. The screws are connected by a rod on each side. Bone graft is then taken from your pelvis and placed alongside the spine to promote fusion. Bone graft substitute may also be used.

The spine fusion is not actually completed at the time of surgery. Instead, the conditions for the spine to fuse are created. The hardware is put in place to temporarily stabilize the vertebrae until your own body has made enough bone to stabilize the vertebrae itself. As you heal, the graft and vertebrae will grow together to become one sold unit. It will take 6 to 12 months for the fusion to become solid. X-rays will be taken periodically to monitor healing

WARNING: Patient’s who smoke or use other tobacco products DO NOT fuse. You must discontinue using all tobacco products before undergoing fusion surgery. Contact the office immediately if you need assistance to quit smoking.



Preparing for Surgery

Arrangements for your surgery and any pre-operative testing are coordinated by the Surgical Coordinator Patricia Wilkerson. Please contact her with any surgical questions you may have at 617-730-9814.

Prescreening

All patients that undergo surgery at the New England Baptist Hospital are required to go to
the hospital for a prescreening appointment prior to the date of surgery. At that visit you will undergo a complete physical examination by the anesthesia department. Blood work, special x-rays and an EKG will be taken. If you are required to see a specialist for surgical clearance (i.e. cardiologist), arrangements will be made for you to see that physician at your prescreening appointment. If other arrangements need to be made, you will be notified. Blood donations, if necessary, may also be scheduled for that day. Please plan on spending a full day at the hospital.

Please bring a small snack and any medications (including pain medications) that you will need to take during the day to your prescreening appointment, as this will be a long day. There is a cafeteria and vending machines on site for your use.

You cannot have surgery without this pre-screening evaluation. If you cannot make your pre-screening appointment, you must call 617-754-5223 to reschedule as soon as possible. You must notify the office as well. If you miss your prescreening appointment your surgery will be canceled. Contact the office immediately if you have any difficulty rescheduling this appointment.

To minimize time spent at prescreening, you are encouraged to pre-register at www.onemedicalpassport.com. Dr. Masons ID number is 0001610056. See the enclosed pamphlet for more information.


Blood Donation

Most patients receive two blood transfusions following an anterior posterior fusion. Therefore, you will be asked to donate two units of your own blood preoperatively to be used for transfusion during or following surgery. One unit is generally donated at your prescreening visit.

Blood donations may also be scheduled at designated American Red Cross facilities. This will be coordinated by the surgical coordinator. Be aware that most Red Cross locations do not provide this service. Family members may also donate blood for the surgery if their blood type is exactly the same. “Universal donors” are not acceptable.

Any blood donated on your behalf is disposed of if not used for your surgical procedure.

Please do NOT eat any food or drink after midnight the night before your surgery. Do NOT eat candy or gum. You may have your morning medications with a sip of water. If you use insulin, do not administer your morning injection. Bring your insulin with you to the hospital.
Hospital Arrival

You must arrive at the hospital at the time provided to you by the surgical coordinator. This will be approximately 1 ½ to 2 hours prior to your surgical time.

Please report to the admitting office immediately to check in. Please bring your insurance card with you. Once you are admitted, you will be escorted to the Bond Center.


Bond Center

Once you arrive at the Bond Center, your will meet the nurse who will be taking care of you that morning. You will be asked to change into a hospital gown. The anesthesiologist will put in an IV in your arm for medications. Your surgeon will see you before surgery.


Length of Surgery

The length of your surgery is dependent on how many vertebrae are involved. The average length of surgery is 4-5 hours. You will be transferred to the recovery room after the surgery is completed. Once you are awake and alert, you will then be transferred to your hospital room.


In Patient Post-Operative Care


Pain

Your low back and abdomen will be very sore following this procedure. Initially your pain will managed with IV medications. Pain medication will be utilized to keep you comfortable. Do not expect to be pain free.

Bowel Discomfort

Your bowels will be manipulated during the anterior portion of your surgery to allow for good exposure of the spine. Therefore, your bowels may not work normally for a few days following surgery. You will be slowly introduced to food as tolerated. We recommend small meals for the first few days, gradually increasing to your normal portions.

Breathing

Breathing exercises are incorporated into your post-operative program to help prevent pneumonia from developing. You will be given a device called an incentive spirometer, to assist you with these exercises.

Bladder Care

Following surgery, it may be difficult to urinate due to the affects of anesthesia. You may have a catheter placed temporarily to help you to urinate.

Clot Prevention

When you are inactive, precautions are taken to avoid the development of blood clots. You may be required to wear elastic stockings post-operatively.

Physical Therapy

Physical therapy begins the day after your surgery. The therapists will assist you in getting out of bed and walking. They will help you to regain your strength and motion so that you may be discharged to home safely.

Your hospital case manager will review your post-operative plan with you before you are discharged. The hospital case manager is responsible for arranging the following services for you if needed:

• Home Physical Therapy
• Inpatient Rehabilitation Transfers
• Home Nursing
• Transportation to Home or a Rehab Center
• Home Health Aides

Rehabilitation Hospital Transfer

You may be transferred to an inpatient rehabilitation center for a short period of time following surgery if you are not ready to go home. If inpatient rehabilitation is needed, this is arranged by the hospital case manager. If you would like to go to a specific rehabilitation hospital, please inform your case worker as soon as possible.

Home Services

If you have been told that you are having home care and you are not contacted within two days of your discharge from the hospital by the home care agency, call the agency’s number that is listed on your discharge papers. If they do not respond, contact the office immediately at 617-730-9814.

Length of Stay

You will be expected to spend 4-5 days in the hospital.

Medications

You will receive prescriptions for pain medications upon discharge. The prescriptions are provided to you by the hospital. You will need to contact the office during office hours for refills. Pain medications cannot be called in or written after office hours or on weekends.

Please keep in mind that many narcotic medications cannot be called in and must be mailed. It is important to call the office several days in advance so that you can receive your medications on time.

Pain medications are designed to make your pain more tolerable. Do not expect to be pain
free.

Medical Equipment

Medical equipment such as a cane, commode, walker, shower chair, etc. is arranged for by the hospital if needed.

Please contact the office immediately if you develop any of the following symptoms after discharge from the hospital:

• a significant increase in pain
• new numbness, tingling or weakness of legs
• fever over 100°F
• new back or leg pain
• severe headaches
• redness or discharge from the incision site

Post Operative Visits


1st Post Op Visit (10-14 days)

You must be seen in the office between the 10th and 14th post-operative day. This is for suture or staple removal, a wound check and pain medication refills. If you are unable to come to this appointment, please contact our office.

2nd Post-Op visit

You will be seen by your surgeon approximately 6 weeks following the date of surgery. You will have x-rays taken that day.


Immediately After Surgery


Incision Care

Dressing: A dressing will be applied to your incision following surgery. This dressing should be left on until your first office visit unless otherwise specified by your physician or physician assistant. Your visiting nurse may receive instructions to remove or change this bandage before your first post-operative visit.

Do not be alarmed if the dressing becomes moist or bloodstained. However, if the area continues to bleed, you should call the office immediately.

Wound Care: Your wound should be kept clean and dry. You should not allow your incisions to get wet in a shower unless otherwise specified by your surgeon.

Incision: Initially the incision appears pink. Over time, with proper care, it will heal into a fine white line. This may take up to one year. For best results, put vitamin E directly onto the incision once it has healed. Keep the incision out of the sun or cover with sunscreen.
Exercise and Precautions

You are expected to walk daily for exercise. Begin with short distances and try to walk two times per day. Do not lift anything greater than 5 pounds.

Pain: Post-operative pain is normal and to be expected. Be sure to take your medications as prescribed. Contact the office with any significant increase in your pain.

Body Mechanics: Maintain proper posture with all activities. Avoid bending, twisting or slouching. Avoid prolonged sitting.

Bone Stimulators: If indicated, you will be provided with an external bone stimulator to be worn with your brace. This may increase the rate of fusion and decrease healing time. You will be notified by your physician if you are a candidate. Please note that some insurance companies will not approve this product.
3-6 Weeks After Surgery

Housework: Do not do any household chores such as bed making, sweeping, dishes, laundry, etc.

Driving: You should not drive for 6 weeks unless told otherwise by the physician.

Intercourse: You should avoid sexual activity for 3-4 four weeks following surgery. Before you resume sexual activity, make your partner aware of your pain and any concerns that you may have. Limit activity and positions that cause pain. The dependent (supine) position is recommended. Avoid twisting and excessive bending of the hips and sudden movements.


12 Weeks After Surgery

Rehabilitation: You will begin outpatient physical therapy approximately three months after the surgery unless advised otherwise by your surgeon.

Bracing: All patients will require a low back brace to be worn post-operatively for a minimum of three months. Patients are usually measured pre-operatively for this brace. On occasion, measurements are taken during your hospital stay.

Work: You are expected to be out of work for a minimum of 12 weeks. This of course varies from person to person. Return to work is dependent upon the rate of healing, symptoms, work demands, etc. If you need disability paperwork completed, please contact the office at the earliest possible date.