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Posterolateral Lumbar Fusion

Posterolateral fusion is one of two main approaches to spinal fusion, a surgery designed to stop low back pain caused by painful motion of the vertebrae. One of the main differences between these two approaches is where the bone graft is laid in the spine to form the fusion.

In posterolateral fusion the graft to form the bony bridge can be placed between the transverse processes in the back of the spine. This will allow the bone to heal from the transverse process of one vertebra to the transverse process of the next vertebra.

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spine. This will allow the bone to heal from the transverse process of one vertebra to the transverse process of the next vertebra.

The most common fixation technique employed in a posterolateral fusion is pedicle screw fixation. This refers to placing screws within the pedicles of each vertebral segment (bilaterally—on both sides of the spine) and connecting them to each other with a metal rod. A one level fusion would fuse two vertebrae and usually uses four screws and two rods. A two level fusion fuses three vertebrae and uses six screws and two rods

CONSULT

In order to obtain a fusion certain basic criteria must be present.

  • A suitable graft must be available to serve as the bridge to connect the vertebra.
  • An appropriate location must be present to lay the bone graft and allow it to heal to each vertebral segment on either end.
  • The bed which this bone graft is being laid in must be prepared correctly and the patient must have the appropriate biology for the graft to fuse. This bed can be prepared by removing the outside covering of the bone (the cortex) and exposing a bed with better blood supply (decortication). It is important that there is contact between the bone and the bone graft and no soft tissue (e.g. muscles, ligaments) in the way.
  • There must be adequate fixation to immobilize this area while the bone graft heals to the vertebral segments. This immobilization is usually provided by internal fixation with metallic screws and rods and/or interbody devices such as cages.

TREATMENT CONSIDERATIONS

Patients with spinal instability in their lower back due to degenerative disc disease, spondylolisthesis or spinal stenosis that has not responded to other non-surgical treatment measures such as rest, physical therapy or medications may be recommended for spinal fusion surgery such as Posterolateral Lumbar Fusion. Patients with spinal instability may experience pain, numbness and muscle weakness in the lower back, hips and legs. 

Consultation With Spine Surgeon

Before prescribing Posterolateral Lumbar Fusion surgery your surgeon considers various factors such as the condition to be treated, your age, health, lifestyle and your expected level of activity after the surgery. Have a complete discussion with your spinal care provider regarding the treatment options available.

PROCEDURE

In a posterolateral fusion, the surgical approach to the spine is from the back through a midline incision that is approximately three inches to six inches long.

  • First, bone graft is obtained from the pelvis (the iliac crest), although some form of bone graft substitute may also be used. Most spine surgeons work through the same incision to obtain the bone graft and to perform the spinal fusion.
  • Next, the harvested bone graft is laid out in the posterolateral portion of the spine. This region lies on the outside of the spine and is a very vascular area, which is important because the fusion needs blood to supply the nutrients for it to grow.
  • A small extension of the vertebral body in this area (transverse process) is a bone that serves as a muscle attachment site. The large back muscles that attach to the transverse processes are elevated up to create a bed to lay the bone graft on. The back muscles are then laid back over the bone graft, creating tension to hold the bone graft in place.
Orthopedic Spine Surgeon Dr Hamid R. Mir M.D.

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Dr. Hamid R. Mir M.D.

Orthopedic Spine Surgeon & Back, Spine, & Neck Specialist

Dr Hamid Mir is a board certified orthopedic spine surgeon & back, spine, & neck specialist with fellowship training in combined neurosurgery and orthopedic spine surgery. He has offices in Orange County, Los Angeles & Riverside. Dr Mir specializes in spinal fusion, lumbar surgery and treating trauma as well as other conditions affecting the lumbar, thoracic, and cervical spine including degenerative diseases, stenosis, fracture, infection, adult scoliosis, revision, and complex reconstructions.

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Testimonials

You are more than just a patient.

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I was in a very bad situation with a herniated disc in my lower back so I made an appointment with DISC spine center and Dr. Hamid. He was very professional and made me comfortable that he understood exactly what I was going through and was able to communicate effectively exactly what it will take to get me on the road to recovery after spine surgery. It took several months as my injury was severe however I always felt I was in good hands under Dr. Hamid’s supervision…If you ever have the misfortune of injuring your circuit board of your body (spine) you need a pro, do not take advice from anyone who’s not specifically licensed to help, Dr Hamid is who I chose and I’m very thankful.

- Matteo B

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Dr. Mir saw me about 2 months before the spine procedure and indicated that I had severe stenosis or narrowing of the openings where the nerve roots exit at the L4, L5 and S1 level. He reviewed my MRI and without wasting any time, asked if I wanted or was considering spinal surgery. He was extremely clear and answered all my questions. I had the procedure done at the Disc Newport OP surgery spine center and was cared for by an incredibly competent, caring staff. I was discharged same day and my post op recovery was 2 weeks, and returned to daily activities and work July 15th. The procedure was very successful as my back pain is basically gone. Amazing relief from a procedure done by a great surgeon with a great team!

- Stan W.

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Dr Mir is an excellent spine surgeon. I had a surgery on my neck by another surgeon but I was still in pain. A friend who had prior spine surgery with Dr. Mir recommended him to me. As the treating surgeon he was very detail oriented, confident, and knowledgeable. His team is very friendly and helpful. I decided to have a second cervical spine operation on my neck. Soooo thankful I have no pain and for physical medicine doctors like him.

- Hillary C.

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Dr. Mir and his entire team of specialists take the extra time and consideration to shape alternatives to meet the needs (holistically) of the patient. Everything about the experience of my surgery was positive. Dr. Mir is a patient and compassionate surgeon. His communication skills are remarkably attentive. We are six months out of the starting gate from surgical treatment, and with PT and core strengthening exercises, this 65 yr. old is back to regular training for next year’s marathon. Thank you kindly El Doc-tor….you are amazing! See you soon.

- Lorena B.

Dr. Hamid Mir is a member of American Board of Orthopedic Surgery with fellowship training in combined neurosurgical and orthopedic spine surgery at Cedars Sinai Medical Center in 2004. As a top rated spine surgeon, he specializes in cervical, thoracic, and lumbar spine diseases including degenerative, stenosis, fracture, infection, scoliosis, revision, and complex reconstructions.

Dr. Mir focused his practice on minimally invasive techniques. As Medical Director of DISC Sports & Spine Center, Dr. Mir is at the forefront of the field of minimally invasive spine surgery. The benefits of these techniques include less post-operative pain, quicker recovery reduced blood loss, less soft tissue damage, smaller surgical incisions, less scarring and improved function.

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