There are many factors which can lead to requiring a Lumbar Fusion. In most cases Conservative Care, like Physical Therapy, is tried before surgical intervention. Some cases that can lead to Lumbar fusion are: spinal instability, continuous nerve injury, failed lami, disectomy, as well as the inability to manage severe pain.
After deciding surgery is required the next step is to decide with the surgeon on the type of surgery. The surgeon can reach the spine through either a posterior (through the back) or anterior approach. If you know the surgeon specializes in one technique, this is usually the way to go. Commonly, part of the Illiac (hip) bone is grafted for use on the spinal vertebrae to help with solidification of the components. Typically, patients complain the area of the hip is more sore than their back following surgery.
Hospital stay following the surgery can be 3- 7 days, or more, if there are complications. PT in the hospital includes learning to transfer in the bed, and rolling out of the bed in a safe manner in order to avoid disrupting the fusion. Next is sitting, and standing and then walking to a chair and around the hospital floor safely. As you heal, walks around the hospital with the therapist, will progress in length, as you can tolerate them. Before you leave the hospital you will also learn how to dress safely, take off and put on the spinal brace, and proper mechanics to move about your house when you are discharged.
After being discharged, you will not be able to drive, sit for long periods, bend, lift or twist. Remember avoid BLT. 6-10 weeks following surgery is Phase II. At this point, you should still be avoiding, BLT, and no lifting more than 10lbs.
Commonly, Physical Therapy begins 6 weeks to 3 months following surgery. PT is important to learn spinal stabilizing exercises. In both the anterior and posterior approach the spinal stabilizing muscles are retracted to gain access to the spine. It is important to strengthen these muscles for functional activities. The research is controversial on this topic but, the fusion can place additional wear and tear on the vertebrae above and below. One way to avoid that excessive movement is to perform proper mechanics and keep your spinal stabilizing muscles strong.
In phase II your walking and activity tolerance will continue to build. At PT you will continue to strengthen and lengthen any muscles that were restricted, as well as monitor you body mechanics. During this time if you had pain down your leg it should be continuing to heal.
During phase III (12-18 weeks) you will continue increasing your activities, movement and strength. However, you will still need to avoid flexion (bending forward) and twisting.
Again, it is best to avoid this surgery in the first place because it is a long rehabilitation, and can place extra stress on the vertebrae above and below. However, if you do require surgery physical therapy can help you return back to work and your life.