When to do a lumbar arthrodesis?

Definition: what is lumbar arthrodesis?

Lumbar arthrodesis is a surgical procedure which consists of fusing vertebrae together to treat back pain. If this technique of consolidation of the vertebrae has been proven for decades, it has evolved enormously. In the past, arthrodesis were not instrumented whereas today, materials are used (screws, rods, metal plates) to unite the vertebrae while bone consolidation takes place. “Less invasive, current lumbar arthrodesis aims to correct the patient’s balance. Thanks to the use of tools offering greater precision, reduces bleeding, pain, consumption of analgesics as well as the length of stay. We are also beginning to see arthrodeses performed endoscopically which combine minimally invasive and endoscopic release“, develops Dr. Steffen Queinnec, orthopedic surgeon.

Indications: when to perform lumbar arthrodesis?

The main indications for lumbar arthrodesis are:

• Spinal deformities such as scoliosis
• THE dislocations due to osteoarthritis
• THE premature wear or not of the disc etiologically unclear
• Disc diseases such as disc degeneration
• There lumbar spondylolisthesis which is characterized by the sliding of one vertebra relative to another
• A spine fracture

“In addition to pain, all these pathologies can induce balance disorders. Arthrodesis helps maintain the column in the correct position“, comments the orthopedic surgeon.

Where to do a lumbar arthrodesis?

Lumbar arthrodesis is a surgical procedure performed by an orthopedic surgeon or neurosurgeon in an operating theatre, under general anesthesia most of the time. The operation lasts approximately three hours and requires on average 1 to 4 nights of hospitalization. Arthrodesis is reserved failure of drug treatment (analgesics, anti-inflammatories, corticosteroids, muscle relaxants, corticosteroid infiltrations, physiotherapy, wearing a lombostat for several months, generally at least 6 months (apart from emergency situations)).

Following lumbar arthrodesis, the consolidation rate is estimated between 90 and 94%.

There are two operating techniques: lumbar arthrodesis by anterior approach and lumbar arthrodesis by posterior approach.
► Lumbar arthrodesis via the anterior approach requires the patient either installed on the back or on the side. The orthopedic surgeon enters the spine via the abdominal route. “This technique provides direct access by being less traumatic on the muscular masses since the muscles are not cut and the visceral elements are bypassed“, argues Dr. Steffen Queinnec.
► Lumbar arthrodesis via the posterior approach: the patient is lying on his stomach. The doctor performs a skin incision in the back passing between the muscles to reach the vertebrae. The bone graft is performed then a cage is placed between two vertebrae to restore intersomatic height. Tools like screws and rods are then put in place to unite the height between the vertebrae and the angulation. During the intervention, the orthopedic surgeon can also perform a neurological decompression and correction of spinal deformity.
“The surgical approach is to be chosen according to the habits of the practitioner, the pathology in question and the material used to stabilize and consolidate the vertebrae.“, specifies our interlocutor.

What is the success rate of lumbar arthrodesis?

“Following lumbar arthrodesis, the consolidation rate is estimated between 90 and 94%. The consolidation rate is correlated to the patient satisfaction rate, which is around 85%. Arthrodesis can show perfect bone consolidation on imaging and yet be responsible for pain“, says Dr. Steffen Queinnec.

How to recover after lumbar arthrodesis?

After the intervention, a few days of hospitalization are necessary to control the pain, change dressings and check for bleeding. “Lumbar arthrodesis changes the anatomy of the body, there is an inflammatory phase and a stiffening phase, the subject must get used to a new posture“, informs the orthopedic surgeon. Indispensable, the convalescence is based on the limitation of the sitting position during the initial phase so as not to put too much stress on the implants. Afterwards, high seating is recommended for a period of 4 to 6 weeks. Wearing a corset can be discussed. Then comes the skin and muscle healing phase, followed by the rehabilitation phase which can last several months with step-by-step phases. “We observe a progression during the first ten months then the result will be almost definitive. Bone consolidation is checked by scanner after one year. It is possible to resume a sedentary office activity after 6 to 8 weeks, then after 3-4 months for standing work. Leisure activities can be resumed gradually“, he continues.

What are the risks of lumbar arthrodesis?

If cases of paralysis are rare, the figures exist and are of the order of 0.5%. They are always sub-lesional, that is to say located below the operated level. The subject may complain of a loss of sensitivity, loss of motor skills which can be temporary or permanent, partial or total. THE infectious risk is also present, much less by the anterior route than by the posterior route. “Several factors increase this risk of infection: smoking which multiplies the risk by almost a factor of 7, diabetes and overweight. The risk hematomas, breaches and lack of fusion (poor consolidation) also exists. Finally, the reoperation rate for adjacent pathologies is important. This is the reason why the post-operative follow-up is closer“, details Dr. Steffen Queinnec.

Are there any contraindications to lumbar arthrodesis?

Contraindications are rare. Do not do arthrodesis if the indication does not seem justified.

Thanks to Dr Steffen Queinnec, orthopedic surgeon at the Institut du Rachis Parisien, SFCR and SRC Member.