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Lumbar Osteotomy and Fusion

What does “Lumbar Osteotomy and Fusion” mean?

Here is the meaning of each word:

  1. Lumbar: area of the spine located in the low-back
  2. Osteotomy: to remove a portion of bone
  3. Fusion: to mend bones together

Altogether, “Lumbar Osteotomy and Fusion” means to remove a portion of vertebrae in the low back and then mending them together.

What is a Lumbar Osteotomy and Fusion?

Lumbar Osteotomies and Fusions are done to help with an abnormal spine curvature in the mid-back. A piece or pieces of the vertebra is/are removed to help change the curvature. The vertebrae are then fused together with titanium screws and rods. The surgery is usually done from the side of the spine through the chest.

Why is a Lumbar Osteotomy and Fusion done?

A Lumbar Osteotomy and Fusion is usually done for a Flat Back Syndrome (link) of the low-back. A Flat Back Syndrome is the loss of the normal backward curvature (lordosis) of the low back. A flat back syndrome creates the feeling of leaning forward or being bent over. Patients often have to bend the knees and hips to create a more upright posture. This can result in pain in the spine and legs as they are chronically trying to compensate for the forward bent posture.

How is a Lumbar Osteotomy and Fusion done?

There are variations of how this surgery is approached. Here are some of the steps of one of the techniques:

  1. An intravenous catheter (IV) is placed and antibiotics are given.
  2. The patient is taken to the Operating Room and initially placed on the back (supine).
  3. A General Anesthetic is given. The Anesthesia Provider places a specialized breathing tube (double lumen tube) into the windpipe. This tube can be used to inflate or deflate one lung at a time.
  4.  The patient is carefully placed on the stomach.
  5. The chest area is cleaned with a sterile surgical solution. Plastic sheets (drapes) are placed around the surgical site.
  6. The surgeon makes a cut (incision) in the low back in the area of the previous surgery.
  7. The tissue and muscles are separated and pushed to the side.
  8. An X-Ray machine is used to find the correct vertebra.
  9. Specialized instruments are used to remove part of the vertebra and possibly adjacent discs. The idea is to make the vertebrae taller in the front than in the back. That can be done by either removing a portion of the back part of the vertebral body in the front, or some of the bone from the back part of the spine (lamina, pedicle, facet joint).
  10. The pedicles of the vertebra to be fused are found with an X-Ray machine.
  11. Titanium screws are placed through the pedicle into each vertebral body. This is done on each side of the vertebra.
  12. Titanium rods are attached to the screws.
  13. Bone or bone-substitute material is placed next to the screws and rods.
  14. The tissue and skin are closed.
  15. The patient is turned on the back (supine) and awoken from Anesthesia.
  16. The patient is then taken to the Recovery Area.

How long does a Lumbar Osteotomy and Fusion take to complete?

The length of this surgery can vary. Here are some of the variables:

The degree of the flat back syndrome the surgery is trying to correct, i.e. what curvature if any is still left.

  • The length of the flat back syndrome, i.e. how many vertebrae are involved in it. The longer the curvature, the longer the surgery takes.
  • The type of Osteotomy chosen. Some types of this surgery remove bone from multiple parts of the vertebra, which takes longer.

Overall, this surgery can take about 4-12 hours or more to complete.

What is the recovery like from a Lumbar Osteotomy and Fusion?

Here are some of the steps for the recovery from a Lumbar Osteotomy and Fusion:

  1. The patient is admitted to the hospital often for 3-5 days or more.
  2. A number of X-Rays are taken during the hospital stay.
  3. Often Physical Therapist help with the initial recovery from surgery.
  4. A firm brace is often used for months after surgery.
  5. The patient will have activity restrictions such as lifting, bending, etc. for weeks to months after surgery.
  6. The wound will take 4-6 weeks to heal.
  7. The surgeon will usually reevaluate the patient in the office within a week after discharge from the hospital.
  8. The Fusion part of the surgery can take 6 months to a year to complete itself.

What type of benefit can patients gain from a Thoracic Osteotomy and Fusion?

Here are some potential benefits from a Thoracic Osteotomy and Fusion:

  1. The correction of the curvature can improve spine pain and leg pain.
  2. The correction of the curvature allows patient to stand and walk straighter.
  3. Potentially less stress is placed on the spine segments above and below the new fusion.