Spondylolisthesis & Spinal Fusion/Fixation

Lumbar decompression and pedicle screw fixation is an operation to relieve back and leg pain caused by a condition called spondylolisthesis- slippage of one lumbar vertebrae forward on another. Decompression is carried out to relieve pressure on the nerve roots and then titanium screws and rods inserted to hold the vertebrae together. On top of this, bone graft may be placed in the disc space (interbody graft) to provide bony fusion for long term relief. The lumbar decompression part of the operation should relieve leg pain in 80-85% of people. The pedicle screw fixation and bone graft part however has a mixed effect on back pain. In the majority back pain should improve, in a smaller number of people it will be worse or it will remain unchanged. When we talk about leg pain we really mean any pain experienced from the mid thigh downwards. Back pain includes that felt over the lower back area, buttock, groin and upper thigh-front and back. Lumbar decompression can also help symptoms of pins and needles and muscle weakness but may not resolve areas of numbness. 

 Overall lumbar decompression and pedicle screw fixation is a safe and effective operation but as with all operations there are risks. The risks include nerve root damage, which can leave you with a numb/floppy foot and/or bladder problems, haemorrhage, infection and fluid leaks. The latter three complications can lead to a longer stay in hospital and/or second or third procedures. These risks are small and at most total 2-5%. There is also the risk of failure to fuse (the bone graft does not take secondary to infection or otherwise). This can lead to recurrence of symptoms and usually further revision surgery. It is a very difficult condition to treat. The risk however is small. 

Most people are admitted on the day of surgery and can expect to go home over the next 2-3 days, often the next day with keyhole surgery. The operation usually takes less than2-3 hours. We get you up as soon as you are able and you are able to go home as soon as you are comfortable. Most people will experience some immediate incisional pain afterwards, but this is considerably less with the keyhole technique.  

The recuperation period varies between people but on average is 6-12 weeks. During this time we encourage people to walk as much as possible, lie as much as possible but to only sit for limited periods (20-30 minutes). You should refrain from driving for 4-6 weeks, longer if you are still in pain. You will be given a set of exercises to do at home after discharge but I do not routinely recommend any further physiotherapy at this early stage. At the 2-3 month stage you should be thinking about taking some more vigorous exercise. Walking, swimming, aerobic classes are all very suitable but please avoid contact sports, rowing machines and lifting weights! Physiotherapy can help if you are having difficulties at this stage.  

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