doi: 10.5435/JAAOSGlobal-D-22-00080. This is done to eliminate uncomfortable motion or restore spinal stability. Only after your doctor can establish the source of your discomfort will they offer. This helps to reduce pain, weakness, numbness, and tingling associated with spinal stenosis. This outcome is commonly referred to as "failed back surgery syndrome". A single copy of these materials may be reprinted for noncommercial personal use only. Office hours: 7am 5pm, Knee Hurts When I Bend It and Straighten It, Burning Pain on Outside of Knee When Kneeling, Muscle Pain After Cervical Fusion Surgery, Basal Joint Arthritis or CMC / Carpometacarpal Arthritis, Common Craniocervical Instability Symptoms, Perc-FSU Trusted Alternative to Spinal Fusion, Perc-ACLR - Regenexx Treatment for ACL Tear, Regenexx Non-Surgical Alternative to Cervical Fusion, Perc-CT SR Alternative to Carpal Tunnel Surgery, Non-surgical Disc Bulge or Herniated Disc Treatment, Regenexx Alternative to Ankle Fusion Surgery, Perc-CMC Alternative to CMC Joint Surgery, Spinal fusion in the United States: analysis of trends from 1998 to 2008, Functional results after anterior lumbar fusion at L5-S1 in patients with normal and abnormal MRI scans, Evaluating rehabilitation following lumbar fusion surgery, Failed back surgery syndrome: definition, epidemiology and demographics, Degenerative lumbar spondylolisthesis with spinal stenosis. The yellow arrows point to the muscles that were injured and now are dead as a result of the fusion surgery. The same forces that can cause the hardware to break can also cause the screws to become loose. American Academy of Orthopaedic Surgeons. The risks of spine surgery include: damage to a spinal nerve unsuccessful treatment, which can lead to pain that persists after surgery a return of back pain, particularly after spinal. Damage to the spinal cord (about 1 in 10,000) Bleeding, major blood vessel injury. This offers new ways to securely walk, stand, and sit. Lumbar fusion can be used to treat a number of painful and degenerative conditions in the low back. 2017 May;26(5):577-585. doi: 10.3171/2016.10.SPINE16317. What are the long-term side effects of spinal fusion? The patients discharge date is determined by their general health, the physicians procedures, and the patients response to the procedure. Epub 2022 Nov 23. Director of Regenerative Interventional Spine Medicine 1992;17(8):940-2. It can take many months to fully recover from spinal fusion surgery 13. On the right, the yellow arrows point to dark healthy spine muscles that were present prior to the surgery. His low back MRI is below and is most significant for the death of the critical low back muscles. Spinal fusion is generally safe. Mjset C, Solberg TK, Zwart JA, Smstuen MC, Kolstad F, Grotle M. Acta Neurochir (Wien). The surgery is joining two bones together, so there is a risk for decreased range of motion, indicates the AAOS, but they note that most patients will not notice a difference. Accessed Nov. 22, 2022. Screws are used in lumbar fusion to stabilize the spine. The low back muscles had gotten 50% smaller and weaker due to surgery. 3rd ed. Although spinal fusion is a surgical procedure used to stabilize and join two or more vertebrae together, it can still cause issues in the long run. The dysphagia usually resolves within days, but there is a risk that it can last weeks to months. So far, the outcomes are promising. This affects patients with large and progressive curves (over 70 degrees) that compress the lungs. Spine (Phila Pa 1976). These can include: blood loss. Electrode failure and migration are the most common. Disclaimer. Medical implants come in a variety of forms, sizes, and styles all of which are meant to treat spinal diseases in individuals of all ages. Spine (Phila Pa 1976) 1998; 23:188192. Experiencing back pain? This additional force in turn can lead to injury of these facet joints and discs leading to degeneration and arthritis. This article does not include a complete list of all potential risks and complications: as with all surgeries, it is advisable to fully review the potential risks and complications with the treating surgeon prior to having ACDF surgery. https://orthoinfo.aaos.org/en/treatment/spinal-fusion. 2023 Jan;165(1):145-157. doi: 10.1007/s00701-022-05440-2. His low back MRI is below and is most significant for the death of the critical low back muscles. When spinal fusion is performed in the . Return of symptoms. 1991 Jul; 73(6):802-8. https://www.ncbi.nlm.nih.gov/pubmed/2071615/. Having a spine that doesn't move in places puts more strain on the areas around the fused part. A recent study looked at the effects of single-level lumbar fusion on spine muscle health (7). Therefore for the very best results, the spine and all its parts need to be evaluated and treated together. This author has been verfied for credibility and expertise. HHS Vulnerability Disclosure, Help Anterior Cervical Discectomy and Fusion (ACDF) Video, Learn how bone growth stimulation therapy can help your healing process. No bending, lifting, or twisting. An official website of the United States government. 2020; doi:10.21037/jss-20-492. In the best of all situations, this risk occurs in a minimum of 20% of spine fusion surgeries. The image on the left is after the surgery. Cauthen JC, Kinard RE, Vogler JB, et al. In: Schwartz's Principles of Surgery. Fusion surgery removes this important shock absorber placing additional stress and forces on the discs and facet joints above and below the level of the fusion. For those who choose spinal surgery, they must realize it takes time to heal. 2014;8(3):281-97. Lumbar spinal stenosis (adult). Fusing usually takes about 3 to 6 months. The screws are stabilized by additional hardware including plates and rods. Fusion surgery removes this important shock absorber placing additional stress and forces on the discs and facet joints above and below the level of the fusion. Local autograft is when the surgeon takes bone from your spine. Spinal fusion is a major surgery where one or more spinal bones (vertebrae) are fused together using screws, bolts, and or plates. Get Veritas Health Newsletters delivered to your inbox. 303-429-6448 Tests say it may be cervical spinal stenosis. Fellowship-trained from Harvard University Differing presentations of severe sacroiliac joint pain, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Back pain after back surgery: The SI joint and adjacent segment disease. Eur Spine J. Some people may have a repeat of their initial symptoms. See if you're a Candidate for Regenexx Back Procedures. All 159 consecutive patients had autogenous tricortical iliac crest bone graft and plate instrumentation used. Dont let your low back pain limit your future. What is a spinal fusion? These structures work with one another in a highly specialized and dependent manner. Schedule a Telemedicine consultation with a board-certified, fellowship-trained physician who can discuss your regenerative options. Therefore, L5 S1 fusion surgery involves the surgical removal of the L5/S1 disc and fusing the L5 and S1 spinal bones together. You have to employ these principles to achieve durable, long-term outcomes that are going to return patients to a much greater quality of a life.". I quit a successful career in anesthesia and traditional pain management to pursue and advance the use of PRP and bone marrow concentrate for common orthopedic conditions. The most common indications for L5 S1 fusion include: Low back disc degeneration Slipped disc ( spondylolisthesis) Spinal Bone Fracture Recurrent Disc Herniation Pain radiating down leg (Sciatica ) Curvature (Scoliosis) Narrowing of the Canal (Stenosis) Failed Spine Surgery with Instability. Avoid strenuous activities of any kind (golfing, tennis, home improvement tasks, etc.). A blood clot can move through the circulation and end up in the lungs on rare occasions. It views the spine and all its moving parts as a whole. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). A blood clot can move through the circulation and end up in the lungs on rare occasions. Patients must stay in the hospital for a period of recuperation and supervision following a spinal fusion. Image shows no significant joint degeneration. Bethesda, MD 20894, Web Policies All statements and opinions are provided for educational and informational purposes only. If there is irregular or excessive mobility between two vertebrae, your spine may become unstable. VA is a recent patient seen in the clinic who experienced this complication. While neck fusion has a good record of eliminating or reducing neck-related arm pain, tingling, and weakness, many patients want to know how much neck mobility might be lost when one or more mobile joints in the neck are fused solidand whether that can impact quality of life. J Bone Joint Surg Am. Eur Spine J. Rajaee SS, Bae HW, Kanim LE, Delamarter RB. Epub 2017 Mar 10. Veritas Health, LLC, 520 Lake Cook Road, Suite 350, Deerfield, IL, 60015, Anterior Cervical Discectomy and Fusion Complications, Cervical Artificial Disc Replacement Technologies, Anterior Lumbar Interbody Fusion (ALIF) Surgery, Anterior Cervical Discectomy and Fusion (ACDF) Video, Potential Risks and Complications of ACDF Surgery, ACDF: Anterior Cervical Discectomy and Fusion, Specific Questions to Ask Your Spine Surgeon, What Causes Buttock Muscle Pain and How to Relieve it, Piriformis Syndrome: When the Symptoms Indicate a Medical Emergency, Massage to Reduce Buttock Muscle Pain from Piriformis Syndrome, Suffering from Lumbar Spinal Stenosis? Accessed Nov. 22, 2022. Axial CT images illustrate two differing presentations of severe sacroiliac (SI) joint pain. A surgeon can get to the spine from the front, known as an anterior spinal fusion. pain drawing, Oswestry Disability Index, and self-assessment of procedure success. Surgeries are often extremely painful and have a very long recovery time. 6.Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis. Mayo Clinic has developed new techniques for the diagnosis and treatment of patients with SI joint dysfunction. Global Spine J. Spine. 1. Treatment options include PRP and your own bone marrow-derived stem cells. For a few days, many patients may not be able to resume a typical solid food diet. Those changes can make pain feel more severe (hyperalgesia) or cause your nervous system to send pain signals for things that shouldn't hurt (allodynia). Intern Med J. The surgeon inserts a bone graft between the vertebrae to permanently fuse them. Spine (Phila Pa 1976) 2000; 25:801803. But study results are mixed when the cause of the back or neck pain is unclear. Pain at the graft site: A small minority of patients will have ongoing discomfort at the location of the bone transplant. You may have acute chest discomfort, shortness of breath, or coughing if this happens. Various procedures for doing spinal fusion surgery have been devised by surgeons. Long Term Effects of a Spinal Fusion The surgery is joining two bones together, so there is a risk for decreased range of motion, indicates the AAOS, but they note that most patients will not notice a difference. Outcome analysis of noninstrumented anterior cervical discectomy and interbody fusion in 348 patients. The long-term side effects of spinal fusion involve non-union, hardware failure, Adjacent Segment Disease, and spinal muscle injury. Accessibility Why would this occur? Oct. 4, 2022. Patients frequently need to wear a back brace after they leave the hospital to keep their spine in good alignment. Harvard Medical School makes some suggestions for alternatives for spinal fusion, as they indicate spinal fusion is only helpful in approximately 50 percent of patients 134. J Am Acad Orthop Surg Glob Res Rev. A small minority of patients will have ongoing discomfort at the location of the bone transplant. Minerva Anestesiologica. So, l5 s1 surgery success rates would reflect in those statistics. Spinal fusion. The information is produced and reviewed by over 200 medical professionals with the goal of providing trusted, uniquely informative information for people with painful health conditions. This blog will focus exclusively on lumbar fusions. The most common indications for L5 S1 fusion include: Low back disc degeneration Slipped disc (spondylolisthesis) Spinal Bone Fracture Recurrent Disc Herniation Pain radiating down leg (Sciatica ) Curvature (Scoliosis) Narrowing of the Canal (Stenosis) Failed Spine Surgery with Instability. Chronic (long-term) pain: A herniated disc, causing nerve damage, is the most common cause of chronic pain after a TLIF. Level of evidence: The best way to avoid these complications is to avoid spinal fusion surgery. Outcomes following anterior cervical discectomy and fusion: the role of interbody disc height, angulation, and spinous process distance. Lumbar fusion surgery has become increasingly popular. AskMayoExpert. Why? 2. Spine Fusion Post-Operative Care, Learn how bone growth stimulation therapy can help your healing process. Adjacent Segment Disease and injury of spinal muscles are additional complications from fusion surgery. At theCenteno-Schultz Clinic, we believe in a comprehensive approach to the treatment of spinal pain. For all diagnostic groups, significant outcomes improvement was seen at all follow-up periods for all scales relative to preoperative scores. PRP and stem cells are injected under x-ray and ultrasound guidance to promote healing and reduction in pain. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. Your doctor uses the two vertebrae on either side of the removed disc to form a bridge (or fusion) across the bone grafts to promote long-term stability. Eur Spine J. Lumbar fusion involves screws, bolts, and plates that stabilize the spinal bones. Spine (Phila Pa 1976). Rajakumar DV, Hari A, Krishna M, Konar S, Sharma A. Neurosurg Focus. Veritas Health, LLC, 520 Lake Cook Road, Suite 350, Deerfield, IL, 60015, Failed Back Surgery Syndrome (FBSS): What It Is and How to Avoid Pain after Surgery, Postoperative Care for Spinal Fusion Surgery, Scoliosis Surgery: Potential Risks and Complications, Treatment for Failed Back Surgery Syndrome Video, Diagnostic Studies, Patient History, and Physical Exams for Spinal Fusion, Additional Spinal Fusion Surgery Factors and Considerations, Back Surgery Video: How Spinal Fusion Stops Back Pain, What Causes Buttock Muscle Pain and How to Relieve it, Piriformis Syndrome: When the Symptoms Indicate a Medical Emergency, Massage to Reduce Buttock Muscle Pain from Piriformis Syndrome, Suffering from Lumbar Spinal Stenosis? During spinal fusion, a surgeon places bone or a bonelike material in the space between two spinal bones. See Failed Spinal Fusion Surgery. [emailprotected] It is most usually extracted from your pelvis, leg, or ribs. The disc is then removed and the area is packed with bone and often times a spacer. When they take cells from the adipose tissue, it is called Minimally Manipulated Adipose Tissue (MMAT) transplant. Spinal fusion connects two or more bones in the spine to make it more stable, correct a problem or reduce pain. Before your treatment, your doctor will go through all of the risks with you and take particular precautions to assist you to prevent any issues. In addition, nerve damage is a rare, but possible long term effect of having a spinal fusion 13. Over the long term, additional surgery for pseudarthrosis (10%) occurred in the early follow-up period, and for adjacent segment degeneration (21%), which occurred linearly during the >10-year follow-up period. With modern techniques happens in approximately 5% to 10% of spine fusion surgeries. Getting ready for the surgery might include trimming hair over the surgical site and cleaning the area with a special soap. Damage to the trachea/esophagus. Anterior cervical decompression and arthrodesis for the treatment of cervical spondylotic myelopathy. There is the possibility that the surgery is not successful in treating the pain and the symptoms return. All can require additional surgery. Why would a lumbar fusion fail? To learn more about this tragic complication please click on the video below. The AAOS recommends starting physical therapy at week 6 and ongoing until 3 months post surgery 13. 2018;8(7):722-7. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. The disc is an important shock absorber. 303-429-6448 National Library of Medicine 2022 Oct 13;6(10):e22.00080. Poor wound healing. At, This method includes extracting the patients healthy cells or autologous tissues, processing them, and reinjecting them into the injury site. eCollection 2022 Oct 1. To better understand how to avoid lumbar fusions by using precisely guided PRP and stem cell injections please click on the video below. 2015;16:251. Spinal cord stimulation risks and precautions About 30% to 40% of people experience one or more complications. Arthritis causes much of back pain. After you go home, contact your doctor if you exhibit signs of infection, such as: It may take several months for the affected bones in your spine to heal and fuse together. This content does not have an Arabic version. Epub 2015 Jan 2. Board certification in Anesthesiology and Interventional Pain Medicine About 3.4% to 10% of people. "SI joint fusion should be no different from any other fusion surgery. Therefore the best results occur when treating the unit as a whole. Anterior cervical discectomy and fusion (ACDF) versus cervical disc arthroplasty (CDA) for two contiguous levels cervical disc degenerative disease: a meta-analysis of randomized controlled trials. Clipboard, Search History, and several other advanced features are temporarily unavailable. These treatments are non-invasive and less painful than conventional methods. Although major loss of the strength and sensation to the legs or loss of bowel or bladder control can occur, it is rare. In those patients with normal MRIs prior to surgery, only 50 % were improved after surgery. "But with force transfer after spinal fusion, the SI joints can move a couple of millimeters," he says. Epub 2022 Dec 8. Prospective cohort study with >10-year follow-up. Rates vary depending upon the specific type of lumbar spinal fusion procedure. Lets dig in. A single copy of these materials may be reprinted for noncommercial personal use only. Elsevier Point of Care. This content does not have an English version. The doctor used live imaging, such as X-rays or ultrasounds, to spot the exact location of the transplant. Trends in lumbar spinal fusion A literature review. Abstract To determine the long-term effects of lower lumbar fusion, 94 subjects were catalogued from medical records. Vertebrae are the small, interlocking bones of the spine. 5.3k views Answered >2 years ago. doi: 10.1007/s00586-008-0695-9, 3.Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis. An important long-term experiment compared spinal fusion to physiotherapy over more than a decade seemed to produce a contradictory result that "prevents a strong conclusion.". Spinal stenosis surgery is a procedure performed to relieve pressure from the spinal cord and/or spinal nerve roots by removing structures from the spine, such as portions of discs, ligaments, and bone. See Potential Risks and Complications of ACDF Surgery. Disk replacement is a new type of spine surgery so there is little information on possible long-term risks and outcomes. L5 S1 Fusion refers to the level of the surgery. Fracture types. . If the damage is permanent, the nerve will not respond to the surgical decompression and your pain will not be relieved. The pain was so severe that you agreed to a lumbar fusion. These treatments are non-invasive and less painful than conventional methods. In most cases, spinal fusion is a generally safe treatment. In our clinic we routinely see patients who have had one, two or even three spinal fusions but develop or continue to have SI joint pain. Alternatively, the same factors that caused the problems at the disc(s) that required surgery may have ultimately impacted the other discs as well. Anybody who has fusion surgery can develop SI dysfunction. Absolutely! Bleeding. Is Minimally Invasive Spine Surgery Right for You? 2015 Mar;22(3):237-45. doi: 10.3171/2014.10.SPINE131089. Possible complications include: Infection. The spinal muscles provide critical stability and support for the spine. B. The procedure employed by the surgeon is determined by the position of the fused vertebrae, the cause for the fusion, and, in certain cases, your overall health and body form. The same forces that can cause the hardware to break can also cause the screws to become loose. Surgery doesn't cure arthritis. Infection. doi: 10.3171/2016.11.FOCUS16412. As a result, spinal hardware might be utilized as an internal splint to keep the spine in place as it heals following surgery. Yes, spinal fusion can cause problems later in life. Causes Thirty-seven per cent complained of persistent graft donor site pain. Dr. Cross notes that SI joints normally move less than 1 millimeter. Full recovery from spinal fusion surgery can take between six months to a year to resume normal activities. Your doctor recommended an L5 S1 surgery. 2004 Nov 15;29(22):2516-20. The disc between the spinal bones is often times removed and replaced with bone or a spacer. For an ACDF surgery, the main potential risks and complications that tend to occur include: By far the most common complication following surgery is difficulty with swallowing, medically known as dysphagia. These issues are more likely to arise in the first few weeks following surgery. Medication may be needed to control the pain. I am a co-founder of the Centeno-Schultz Clinic which was established in 2005. Mayo Clinic does not endorse companies or products. There is the possibility that the surgery is not successful in treating the pain and the symptoms return. 1991 Jul; 73(6):802-8. https://www.ncbi.nlm.nih.gov/pubmed/2071615/. To relieve discomfort, increase stability, or rectify a deformity, spinal fusion permanently joins two or more vertebrae in your spine. Its time to free yourself from the pain and limitation. The likelihood of this result becomes even more frequent with fusions of three or more levels. All rights reserved. J Am Acad Orthop Surg Glob Res Rev. Lumbar spine fusion: what is the evidence. Non-union occurs when the spinal bones that are bolted together fail to fuse or grow together. In: Operative Techniques: Spine Surgery. Br J Pain. If symptoms develop from the same disc level following surgery, it is usually because the bones did not successfully heal togetherwhich is called a nonunion or pseudarthrosis. Spinal instrumentation is a long-term remedy for spinal instability. Trials. . Platelets are the bodys first line of defense against injuries. Summary of background data: Delayed Esophageal Perforation Diagnosed 12 Years After Anterior Cervical Diskectomy and Fusion: A Case Report and Review of Current Literature. 11th ed. PLoS One. PLIF, posterior lumbar interbody fusion is a case in point that has been reviewed in detail in a prior blog. The most common risk of any of the modern spine fusion surgery techniques is the failure to relieve lower back pain symptoms following the surgery. Mayo Clinic; 2021. Implant failure, particularly early after back surgery, is a sign of persistent severe spinal instability. Collectively about 1 in 10 patients who have a low back fusion will need a second surgery to fix non-union or hardware failure (8). A spine surgeon will use more bone, known as a bone graft, to encourage bone fusion. Medical implants come in a variety of forms, sizes, and styles all of which are meant to treat spinal diseases in individuals of all ages. The recovery period is generally six to eight weeks, with some people experiencing intense pain for several days or more following either the trial period or permanent implantation of the spinal cord stimulation devices. This site is for educational purposes only; no information is intended or implied to be a substitute for professional medical advice. To stabilize the spine, screws are placed into the spinal bones above and then below the disc that is removed. eCollection 2022. "The SI joint is often glossed over as a pain generator, especially in people who have had spinal fusion and experience continued pain," says William W. Cross III, M.D., an orthopedic surgeon at Mayo Clinic in Rochester, Minnesota. These structures work with one another in a highly specialized and dependent manner. Lumbar transpedicular implant failure: a clinical and surgical challenge and its radiological assessment. Pflugradt is a freelance writer and registered dietitian with experience in clinical nutrition and outpatient counseling for diabetes management and weight loss. Would you like email updates of new search results? Adjacent Segment Disease After Posterior Lumbar Interbody Fusion: A Case Series of 1000 Patients. Copyright 2023 Leaf Group Ltd., all rights reserved. Can the hardware break or malfunction in any way? The surgery involves cutting through important muscles, ligaments, and tendons to access the targeted disc. Next Page: If they break off and migrate to the lungs, they represent a serious threat. Sometimes, surgery on the spinal bones of the neck occurs from the front. 2017 Apr;26(4):985-997. doi: 10.1007/s00586-016-4655-5. Singleton M, et al. Impact of Gender on Postsurgical Outcomes in Patients Undergoing Anterior Cervical Discectomy and Fusion. Pain at the bone graft site. What causes spinal fusion to fail? The rate of occurrence of potential risks and complications is variable and dependent mainly on a combination of the following factors: See Quitting Smoking Before a Spinal Fusion. Because there are a significant number of variables involved including the specific surgical approach, preoperative MRI, and x-ray finding, the results from pressuring the disc, patients age, medical history, and the parameters studied. Make a donation. This therapy can help with. J Neurosurg Spine. If your initial symptoms return, tell your doctor so they can figure out whats causing them. 2..Gill K, Blumenthal SL. Over time, living with chronic (long-term) pain can have serious or even severe consequences. Inadequate symptom relief after the surgery, Failure of bone graft healing to create a fusion (a non-union, or pseudarthrosis), Temporary or persistent swallowing (medically known as dysphasia), Potential speech disturbance from injury to recurrent laryngeal nerve that supplies the vocal cords, Damage to the spinal cord (about 1 in 10,000). Make a donation. Salamanna F, Contartese D, Tschon M, Borsari V, Griffoni C, Gasbarrini A, Fini M. Front Surg. 2008;17(8):11071112. What Are The Long Term Effects of Spinal Fusion? J Bone Joint Surg Am 1993; 75:12981307. Potency is not affected, and the sensation of sex is still largely the same. Adjacent-level arthroplasty following cervical fusion. 5.Tsutsumimoto T, Shimogata M, Yoshimura Y, Misawa H. Union versus nonunion after posterolateral lumbar fusion: a comparison of long-term surgical outcomes in patients with degenerative lumbar spondylolisthesis. Implant failure, particularly early after back surgery, is a sign of persistent severe spinal instability. J Bone Joint Surg Am. There is a small plexus of nerves in front of the L5-S1 disc space that helps control ejaculation. Location: 5741 S Fort Apache Rd suite 100, Las Vegas, NV 89148, USA, 2023 Cellaxys. // Leaf Group Lifestyle, Complications With an L5-S1 Spinal Fusion, National Institute of Neurological Disorders and Stroke, The AAOS recommends starting physical therapy, The Open Orthopaedics Journal: Risk of Complications in Spine Surgery: A Prospective Study, Harvard Medical School - Harvard Health: Turning Your Back on Back Surgery, NIH: National Institute of Neurological Disorders and Stroke: Low Back Pain Fact Sheet, Wang J., Dailey A., Mummaneni P., Ghogawala Z., Resnick D., Watters W., Groff M., Choudhri T., Eck J., Sharan A., Dhall S., Kaiser M. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Transforaminal lumbar interbody fusion. Patel MR, Jacob KC, Parsons AW, Vanjani NN, Prabhu MC, Pawlowski H, Singh K. Int J Spine Surg. Is there an effective, natural alternative to spinal fusion? FOIA Absolutely. Functional results after anterior lumbar fusion at L5-S1 in patients with normal and abnormal MRI scans.
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