Spinal Procedures

A/Prof Aaron Buckland


Single-Position Lumbar Fusion

Single-position lumbar fusion surgery is an advanced surgical technique that allows both the anterior and posterior aspects of the spine to be accessed and treated without needing to reposition the patient during the procedure. This approach is designed to improve efficiency, reduce surgical time, and enhance patient outcomes while reducing complications.

Why Choose Single-Position Lumbar Fusion?

This technique is particularly beneficial for patients requiring spinal fusion at multiple levels or those who need both anterior and posterior surgical approaches. Posterior fusion techniques have lower fusion rates that fusion of both the anterior (front) and posterior (back) columns of the spine together. Traditionally, anterior-posterior lumbar fusion often required repositioning the patient during surgery, which can increase the duration of the operation and the risks associated with prolonged anaesthesia. Single-position surgery combines all the benefits of minimally invasive fusion, while providing gold-standard fusion rates and alignment restoration.

What Happens During Single-Position Lumbar Fusion Surgery?

Preparation
  • Hospital Admission: You will be admitted on the day of surgery and required to fast prior to the procedure, as instructed by your anaesthetist.
  • Anaesthesia: The surgery is performed under general anaesthesia, ensuring you are asleep and pain-free during the entire procedure.
Surgical Approach
  • Patient Positioning: The patient is positioned in a lateral decubitus (side-lying) position, or in a prone (face down) depending on the specific goals of the surgery. This positioning allows A/Prof Buckland to access both the anterior (front) and/or lateral (side) and/or posterior (back) aspects of the lumbar spine without needing to reposition the patient.
Anterior/Lateral Lumbar Access
  • Incision: A small incision is made on the side of the abdomen to access the lumbar spine from the front. The access to the spine is made without needing to divide any muscles, and may be performed with the assistance of a Vascular Surgeon, depending on the disc level.
  • Disc Removal: The damaged or degenerated disc is removed, and any necessary bone spurs or other structures compressing the nerves are addressed.
  • Insertion of Cage and Bone Graft: A cage (spacer) filled with bone graft material is placed in the disc space to restore disc height and facilitate fusion between the vertebrae. This helps to relieve pressure on the nerves and stabilize the spine.
Posterior Lumbar Access
  • Incision and Exposure: Without repositioning the patient, A/Prof Buckland then accesses the posterior part of the spine through two small incisions on the back.
  • Screw and Rod Placement: Pedicle screws and rods are inserted into the vertebrae using computer assisted navigation technology to stabilize the spine and promote fusion. The implants are typically made of titanium.
  • Decompression: If necessary, additional decompression procedures, such as laminectomy or foraminotomy, are performed to relieve pressure on the spinal nerves via the incision used for placing the screws.

A/Prof Buckland (right) places computer-navigated pedicle screws while Mr Domenic Robinson (Vascular Surgeon (Left)) performs the anterior (front) exposure.

Closure

The surgical wounds are closed with sutures, and sterile dressings are applied to protect the incision sites. The image on the right shows surgical scars two weeks after single-position lumbar fusion.

Postoperative Care and Recovery

Hospital Stay
  • Most patients stay in the hospital for 1-3 days following single-position lumbar fusion surgery, depending on the extent of the surgery and individual recovery progress.
Pain Management
  • Pain is managed with medications, and early mobilization is encouraged to minimize complications like blood clots or pneumonia. Patients typically experience less postoperative pain due to the minimally invasive nature of the surgery. Most patients are able to cease pain medications within 2-4 weeks after surgery.
Outpatient Rehabilitation
  • Physiotherapy: A rehabilitation program tailored to your specific needs will be initiated shortly after surgery. This will focus on restoring strength, flexibility, and proper body mechanics.
  • Activity Restrictions: Patients should avoid heavy lifting, bending, and twisting for at least 3 months after surgery. Gradual return to normal activities is guided by A/Prof Buckland’s team at follow-up visits.
Follow-up
  • Follow-up appointments will be scheduled to monitor your recovery, typically at 2 weeks, 6 weeks, 3 months, 6 months, and 12 months post-surgery.

Patient-Reported Outcomes and Results

Lumbar Fusion Surgery significantly improves function and pain in the majority of patients. Learn more about A/Prof Buckland’s patient-reported outcomes of 1-2 level lumbar fusion here.

Patient Reported Outcomes - 1-2 Level Fusion

A/Prof Buckland has published extensively in the field of single-position surgery, including the demonstrated benefits. The following publications are available for review of this technique.

 

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