Minimally Invasive Anterior Lumbar Interbody Fusion

WHAT YOU SHOULD KNOW:

Minimally invasive anterior lumbar interbody fusion is surgery to repair vertebrae in your lower back (lumbar). In this surgery, 2 or more vertebrae are joined together using bone grafts or implants, screws, and rods. The surgery is usually done to treat disc disease. Lumbar discs cushion and separate the vertebrae in your back. A minimally invasive anterior lumbar interbody fusion is done through small incisions in the abdomen.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

Problems may happen during your surgery, such as bleeding that cannot be controlled, and may lead to laparotomy (open surgery). Your stomach, intestines, blood vessels, or kidneys may get injured. You could also have trouble breathing, get an infection, or have too much bleeding after surgery. The gas that is used to expand your abdomen may cause shoulder or chest pain for 1 to 2 days after your surgery. Other parts near your spine, such as nerves, blood vessels, ligaments, muscles, and bones may be damaged. You may develop foot weakness or lose feeling in your legs.

Even after surgery, you may still have back pain or problems moving your back. You may have trouble going back to your usual activities. Without treatment, the pain and problems you have with your back may get worse. You may even have problems moving your legs.

WHILE YOU ARE HERE:

Before your surgery:

  • Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

  • General anesthesia will keep you asleep and free from pain during surgery. Anesthesia may be given through your IV. You may instead breathe it in through a mask or a tube placed down your throat. The tube may cause you to have a sore throat when you wake up.

  • Enema: You may need to have an enema before your surgery. This is liquid put into your rectum to help empty and clean your bowel.

  • An IV is a small tube placed in your vein that is used to give you medicine or liquids.

  • Nasogastric (NG) tube: An NG tube is put into your nose, and passes down your throat until it reaches your stomach. Food and medicine may be given through an NG tube if you cannot take anything by mouth. The tube may instead be attached to suction if caregivers need to keep your stomach empty.

  • Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.

  • Monitoring:

    • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.

    • Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.

    • Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

  • Tests:

    • Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.

    • Computerized tomography scan: This is also called a CT or CAT scan. An x-ray machine uses a computer to take pictures of your back. It may be used to look for injury or abnormal changes in bones or muscles.

    • Magnetic resonance imaging: This is also called MRI. During the MRI, pictures of your back are taken. An MRI may be used to check the parts of your back, such as the muscles and blood vessels. It may also be used to look for other problems.

    • X-rays: Before surgery, caregivers may want to have an x-ray of your back. Caregivers use it to see the injury inside your back before surgery.

During your surgery:

  • You are asked to lie on your back. Your abdomen and chest are cleaned with soap and water. Sheets are put over you to keep the surgery area clean.

  • During a mini-open surgery, a small incision is made below the belly button. In a laparoscopic surgery, 3 to 4 smaller incisions are made near your belly button. Caregivers insert a laparoscope and other instruments into the incisions. The abdomen is filled with carbon dioxide. This lifts the wall of the abdomen away from the internal organs and allows your caregiver more space to work in.

  • Once the spine is seen, the disc and excess tissues in the affected area are removed. Bone grafts and implants are inserted between the affected vertebrae in place of the damaged disc. Screws and rods are used to hold the bone graft and implant firmly. The incisions are closed with stitches and covered with a bandage.

After your surgery:

You may be taken to a recovery room until you are fully awake. Caregivers will watch you closely for any problems. Do not get out of bed until your caregiver says it is okay. When caregivers see that you are okay, you will be taken back to your hospital room. The bandages used to cover your stitches keep the area clean and dry to prevent infection. A caregiver may remove the bandages soon after your surgery to check your wound.

  • Activity:

    • Until you can get out of bed, start doing leg exercises. Do this by drawing circles with your toes. This will make your leg stronger and stop blood clots from forming.

    • It is important to get moving as soon as possible after surgery. Ask your caregiver when you can get up for the first time. Any time you feel weak or dizzy, lie down right away and call your caregiver.

  • You will be able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft foods easily, you may slowly begin to eat solid foods.

  • Drains: These are thin rubber tubes put into your skin to drain fluid from around your incision. The drains are taken out when the incision stops draining.

  • Medicines: You may be given the following medicines:

    • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.

    • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.

    • Medicines to treat pain, swelling, or fever: These medicines are safe for most people to use. However, they can cause serious problems when used by people with certain medical conditions. Tell caregivers if you have liver or kidney disease or a history of bleeding in your stomach.

  • Monitoring: Caregivers will take your vital signs frequently for several hours. The pulses on your legs and in your feet may also be checked often. This may help the caregiver to learn if you have any problems with blood flow after your surgery.

  • Oxygen: You may need extra oxygen if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your caregiver before you take off the mask or oxygen tubing.

  • Pneumatic boots: Inflatable boots are put on your legs. The boots are connected to an air pump. The pump tightens and loosens different areas of the boots. This helps improve blood flow to prevent clots.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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