Lumbosacral and Pelvic Procedures


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Spinal fusion is typically an effective treatment for fractures, deformities or instability in the spine. But study results are more mixed when the cause of the back or neck pain is unclear.

In many cases, spinal fusion is no more effective than nonsurgical treatments for nonspecific back pain. It can be difficult to be certain about what exactly is causing your back pain, even if a herniated disk or bone spurs show up on your X-rays.

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Many people have X-ray evidence of back issues that have never caused them any pain. So your pain might not be associated with whatever problem has been revealed on your imaging scans. Even when spinal fusion provides symptom relief, it does not prevent you from developing more back pain in the future. Most of the degenerative conditions in the spine are caused by arthritis, and surgery will not cure your body of that disease. Immobilizing a section of your spine places additional stress and strain on the areas around the fused portion.

This may increase the rate at which those areas of your spine degenerate — so you may need additional spinal surgery in the future. Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease. Spinal fusion care at Mayo Clinic. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. This content does not have an English version. This content does not have an Arabic version. Overview Spinal fusion is surgery to permanently connect two or more vertebrae in your spine, eliminating motion between them.

Request an Appointment at Mayo Clinic. Fusion from back of neck When spinal fusion is performed from the back of the neck posterior cervical fusion , rods and screws are used to hold the vertebrae together. Fusion from front of neck In some cases, surgery on your neck cervical vertebrae occurs from the front anterior side of your neck. Fusion options for lower back Depending on whether your surgeon approaches your spine from the front anterior spinal fusion or from the back posterior spinal fusion , the vertebrae will be fastened together either with a metal plate or with rods and screws.

Share on: Facebook Twitter. References Spinal fusion.


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American Academy of Orthopaedic Surgeons. Accessed Dec. Chou R. Subacute and chronic low-back pain: Surgical treatment. The lower instrumented level was L5 in 8 patients, S1 in 7 patients. S1 screws loosening occurred in 2 cases, and no screw loosening was found in L5 screws. In this series, the number of levels with TLIF did not correlate with the onset of surgical complications. There was no significant difference between group 1 and 2 in terms of the number of TLIF. Furthermore, 4 out of 5 cases with screw loosening or breakage had undergone TLIF at the affected segments.

Only 1 case with the top screws loosening had no TLIF at the affected level.


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The two groups were similar with regard to the mean preoperative JOA score However, the difference of postoperative JOA score 13 and The difference between the preoperative and postoperative JOA was significant in group 2. These complications occurred after 5. We think that the LL is an important preoperative consideration in determining how much correction should be done and how many levels should be fused. We identified the trend that the choice of UIV level influenced the overall rate of proximal failure in line with previous reports.

As well, Lewis et al.

Lumbar Spinal Stenosis – Symptoms, Diagnosis and Treatments

They also emphasize that most proximal screws should be put on horizontally-oriented vertebra in sagittal section. Extension of fusions up to thoracic levels could provide more stable construct, however, all cases do not have to be fused up to thoracic levels. As claimed by Shufflebarger et al. Lumbosacral pseudarthrosis is likely to come up as S1 screw loosening, as seen in this study.

However, iliac screws seem to be a problem of this implant sometimes becoming symptomatic. Instead, S2 sacral alar-iliac SAI screws, which have previously been reported as an interesting alternative to classic iliac wing screws, could be used in the initial surgery or as a salvage technique for lumbosacropelvic instability.

We noted a high surgical complication rate of long fusion for degenerative scoliosis or kyphosis in our series of We attribute the high failure rate to a multitude of factors. The most important is related to sagittal balance as previously reported. Second, we failed to create adequate LL in harmony with PI in group 1. PI is a morphological pelvic parameter that remains consistent during a patient's lifetime, with slight changes occurring during prepubertal development. Following puberty, PI is generally considered to be a fixed morphological parameter, reflecting the relationship of the sacrum to the pelvis.

Therefore, a ground rule of harmonious alignment consists of a LL proportional to PI.

Before the operation

In contrast, group 2 had better balance pre- and postoperatively with a PI—LL of This implicates the low LL relative to PI accounts for the high instrumentation failure rate in this series. Treatment goal should be adapted to a given individual on the basis of their respective realignment needs.

The relationship between the result of radiographic study and clinical outcome was analyzed with linear correlation and regression analysis. From these findings, the restoration of the LL angle should be much emphasized on in the surgical procedure. Other factors contributing to the high failure rate are involving surgical technique, which include inadequate osteotomy, use of single TLIF cage at each level, high reliance on local bone graft. Given these facts, posterior-only approach would require the following techniques to achieve solid fusion and appropriate restoration of LL leading to low complication rate: 1 more aggressive osteotomy with thorough release of the posterior and anterior structure should be adopted because hyperplasia of the articular process and osteophyte bridging neighboring vertebral body could prevent the adequate restoration of LL, 28 2 for those patients with severe segmental kyphosis, multisegmental TLIF technique should be applied with two interbody cages put in the anterior part of the intervertebral disc space.

Like other studies, this series is limited by the small numbers. Nevertheless, we think that our conclusions related to fusion levels, sagittal imbalance, and surgical procedures are significant findings. A multicenter setting based on this study results may help further validate these findings and other findings in this study to provide surgeons with a better understanding in choosing appropriate surgical strategies for their patients with degenerative lumbar conditions.

Our series of long lumbar fusions had a high surgical complications and revision rate.

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Under correction of the sagittal balance in this series may have contributed to most of the poor outcomes and we may have to extend the fusion until thoracic level to attain the satisfactory lordosis. This study also showed that there was a positive correlation between the increase in JOA score and the increase in the LL angle, which was consistent with earlier studies.

On the basis of the findings of this study, we recommend that long lumbar fusion should be performed long enough to achieve an adequate LL properly proportional to PI. National Center for Biotechnology Information , U.

Neurol Med Chir Tokyo. Published online Aug Author information Article notes Copyright and License information Disclaimer. Conflicts of Interest Disclosure The authors have no conflicts of interest. Received Jan 27; Accepted Jul 1. This article has been cited by other articles in PMC.

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What is a lumbar MRI scan?

Abstract The outcomes and complications of posterior-only lumbar instrumented long fusions exceeding three segments with selective segmental transforaminal lumbar interbody fusion for the treatment of degenerative lumbar scoliosis, kyphosis, or both combined with spondylolisthesis were analyzed to investigate risk factors associated with surgical instrumentation failure.

Keywords: lumbar scoliosis, lumbar kyphosis, transforaminal lumbar interbody fusion, lumbar lordosis angle, pelvic incidence. Introduction Long lumbar instrumented fusions have been described for various conditions, including degenerative lumbar scoliosis, adolescent idiopathic scoliosis, lumbar kyphosis, degenerative spondylolisthesis, and revision cases such as pseudarthoses.

Your radiologist and doctor will review the X-rays and discuss their findings. Results from your X-ray may be available the same day. Your doctor will determine how to proceed depending on what the X-rays show. They may order additional imaging scans, blood tests, or other tests to help make an accurate diagnosis. Lumbar arthritis isn't a condition.

What is lumbar spinal stenosis?

It's a symptom of several forms of arthritis that affect the spine. Here's why it happens and how to find relief. If you live with osteoarthritis, you know it's a complex condition with a broad range of treatments and risk factors. Here's a detailed, top-to-bottom…. Osteoporosis is a bone disease that causes a loss of bone density, which increases your risk of fractures. Learn about its causes, risk factors, and….

Lumbosacral and Pelvic Procedures Lumbosacral and Pelvic Procedures
Lumbosacral and Pelvic Procedures Lumbosacral and Pelvic Procedures
Lumbosacral and Pelvic Procedures Lumbosacral and Pelvic Procedures
Lumbosacral and Pelvic Procedures Lumbosacral and Pelvic Procedures
Lumbosacral and Pelvic Procedures Lumbosacral and Pelvic Procedures
Lumbosacral and Pelvic Procedures Lumbosacral and Pelvic Procedures
Lumbosacral and Pelvic Procedures Lumbosacral and Pelvic Procedures

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