Surgery of the lumbar intervertebral fusion with posterior approach

The surgery of the intervertebral fusion with posterior approach and posterior stabilization is performed when there are deformities or instability one or two segments of the spine with or without the adjacent spinal canal stenosis and/or intervertebral foramina (spinal and foramina stenosis).

The consequences of these changes are loss of correct posture and stability of the lumbar spine with possible damage to the lumbar spinal nerves. An open type posterior approach with three parts is used in this surgery.

The first part of the surgery is to approach the bony part of the spine. After the skin and muscle fascia cut, paravertebral muscles are removed from the spine to show the bony parts.

The second part of the surgery is the process of intervertebral fusion with posterior approach. In this part, a section of the vertebral lamina is removed, and the intervertebral disc is approached next to the spinal nerves. It is removed totally. In the empty intervertebral space, the surgeon inserts the patient's own (autogenous), foreign (allogenous) or artificial (alloplastic) bone and intervertebral cage with which fusion of the vertebral bodies is achieved (TLIF or PLIF). Optionally, in this part of the surgery, changed ligaments and bones which press on the spinal nerve sin the spinal canal od intervertebral foramina are removed.

The third part of the surgery the posterior stabilization of the spine (posterior spondylolisthesis). In this part, screws are inserted in the vertebra and then they are connected with a longitudinal element (most likely a bar) and complete stability of the spine segments that underwent surgery is achieved.

After surgery external immobilization (rigid lumbar orthosis) can be used until spondylolisthesis occurs. The therapeutic effect of this surgery is individual. In most patients, the degree of low back pain and/or sciatica reduces. A few months after rehabilitation are necessary for full recovery. In a small number of patients, some difficulties can return after a few months or years.

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