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Improving the Healing of Lumbar Fusion Surgery

Dr. Carlson

Jeffrey R. Carlson, MD, MBA, CPE, FAAOS 

As patients prepare for low back surgery that involves fusing the spinal bones together, I’m often asked what can be done to make the outcome of the procedure successful.   Success is usually defined by patients as the immediate cessation of their nerve and back pain, so they can return to their former, pre-pain lifestyle.  They also want this improved, pain-free condition to continue for the rest of their lives.  Patients have no desire to undergo this surgery again.

Decompression surgery is very good at taking the pressure off the nerve roots and fixing the debilitating sciatic pain, but that is only half the procedure required to maintain a long-term result in patients that have bones that are unstable.  If the vertebrae are slipping or moving abnormally, then those spinal bones will need to be stabilized to prevent the pressure on the nerve from recurring.  This stabilization is termed “fusion”. A successful spinal fusion is achieved when bone cells make a bridge of bone which connects the previously moving vertebrae together into one solid bone, so the bones no longer move.

Factors Affecting Spinal Fusion Success

There are several variables that can affect how well and how fast the bones fuse together.  First, the quality of the bone at the time of surgery can affect how well the fusion progresses.   In the older population, bone begins to lose cells that help to maintain the strength and resilience of the bone. These patients have a condition called osteopenia, which limits their bone’s healing potential.  We can improve our bone quality and healing potential by maintaining weight-bearing activities and keeping up with our dietary calcium and Vitamin D.

Next, the stability gained at the time of surgery influences fusion rates. Older techniques of using an external brace for stability have been found to have less successful fusion rates than new techniques involving internally implanted screws and rods to provide an immediate, more rigid bone structure.  Because the internal hardware provides such rigidity, patients do not have to wear an external brace for an extended period of time and can return to their usual activities sooner. Increasing activity, safely and as soon as possible, allows the body to heal more quickly.

There are also modifiable patient-related factors, including smoking and anti-inflammatory medication use that are known to decrease fusion rates.  A recent study has determined a new risk factor that leads to the potential of non-union.   Surgeons in Ohio evaluated just over 52,000 patients that had undergone lumbar spinal fusion between 2002 and 2021 (Spine 49(6): pages 369-377, March 15, 2024).   They were able to divide those patients into two groups; those with high cholesterol and those that were on statins and had a normal cholesterol level.  They found those with high cholesterol were almost two times more likely to not heal their fusion surgery. They felt the high cholesterol clogged the arteries supplying nutrition to the surgical area just as it can block arteries to the heart.  This ground-breaking research has identified a previously unknown risk factor that can double a person’s odds of having a non-union.

How to Decrease Spinal Fusion Recovery Time & Improve Outcomes

If your lumbar fusion surgery is done with hardware, you can increase your chances for successful fusion by:

  • maintaining your body’s health with exercise
  • avoiding/quitting smoking (that includes vaping and smoking cannabis)
  • no anti-inflammatory medication while the surgery heals
  • maintaining a normal cholesterol level/taking statins for cholesterol control

Dr. Jeffrey Carlson is a Fellowship-trained and board-certified Spine Surgeon who treats all injuries to and disorders of the spine.  Dr. Carlson is an innovator in spine surgery instrumentation and technique and has pioneered many spine surgeries, including the world’s first three-level lumbar fusion in an Ambulatory Surgery Center at Coastal Virginia Surgery Center in Newport News, Virginia, United States.

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