Many lumbar spine conditions — or those affecting the low back — can be treated using methods other than surgery. Your orthopedic specialist will likely try non-operative treatment for a period of up to several months before exploring the possibility of lumbar spine surgery. If your doctor does determine that lumbar surgery is indicated, here is an overview of the main types of surgery that are most frequently performed:
Fusion for the Lumbar Spine
Fusion involves the removal of disc and replacement with bone graft, or cage-filled bone graft, or a bone graft substitute learn more about the lumbar spine anatomy here). It can be done using an:
- Anterior approach
- Posterior approach
- Combined approach
Fusion is a surgical procedure that can be used to treat:
1) Spondylolisthesis: A spine condition that develops when a vertebral bone slips over an adjacent vertebra. It can occur over time as a progressive slip, and be a partial or complete dislocation.
2) Spondylolysis: A fracture or defect in the vertebra. It can occur or without spondylolisthesis.
3) Degenerative disc disease (DDD): A condition that occurs when discs break down over time, and become less resilient to stress and strain. DDD usually comes with another diagnosis.
An orthopedic doctor will attempt to treat all of these with nonsurgical treatment such as rest, anti-inflammatory medication, prescribed exercise routines and physical therapy. If these methods fail, lumbar spine surgery may be called for.
Some conditions, such as herniated nucleus pulposus (HNP) rarely require surgery. In cases where surgery is needed for HNP, a discectomy might be used. It involves removing the herniated portion of the disc, usually through a small incision. This procedure has a high rate of success.
Different Kinds of Fusion
Your orthopedic surgeon may take several different approaches to a lumbar fusion surgery, depending on the specifics of your condition.
Posterior Lumbar Fusion
Posterolateral fusion (PLF) is used to treat spondylolisthesis and spondylolysis without disc involvement. The procedure usually includes the use of screws or rods for stabilization until the fusion occurs over time.
Posterior lumbar interbody fusion (PLIF) is used with disc involvement in conjunction with PLF. It usually also includes the use of screws rrods for stabilization until the fusion occurs. It also involves a bone graft and cages.
Transforaminal lumbar interbody fusion (TLIF) is used with disc involvement with or without PLF. Again, it usually includes the use of screws and rods for stabilization until the fusion occurs and includes the use of bone graft and cages. It does involve less soft tissue and bone trauma.
Anterior Lumbar Fusion
Anterior lumbar interbody fusion (ALIF) is used in cases with disc involvement primarily with, but sometimes without, PLF. It involves the use of bone graft and cages.
Athroplasty for the Lumbar Spine
Arthroplasty involves the replacement of degenerating joints. It can be referred to as total disc replacement (TDR) and is used to treated DDD. It is contraindicated — meaning it should not be used — for spondylolisthesis and spondylolysis.
If you have lumbar spine pain or believe you may need treatment or even surgery for the lumbar spine, talk to an orthopedic specialist.