MINIMALLY INVASIVE LDF INSTRUCTIONS
Call 913-955-3300 to make a follow up appointment to be seen with x-rays
Surgical procedure information can be viewed as two videos at:
UnderstandSpineSurgery.com: Part 1 & Part 2
Stenosis can occur in any portion of the spine and is caused by degenerative changes in the disc space, bones,
and ligament structures. As the degeneration occurs, the space for the nerve roots becomes compressed.
Symptoms are related to the area of compression.
Spondylolisthesis is present when one vertebra is offset from the vertebrae below creating additional stenosis. This
segment may not be as safe to decompress due to risk of the development of increased instability. The fusion is
added to the decompression to stabilize the segment and allow for wider decompression of the area of stenosis.
Lumbar decompression is performed to remove the compression from the nerve roots. This may be performed at
one or more levels as required to accomplish the task. The surgery takes 2 to 4 hours, depending on the levels
involved. Minimally invasive spine surgery is designed to minimize tissue trauma and disruption to the normal spine.
Incisions are placed to provide the most appropriate access to the area of the spine which needs to be
decompressed. Incisions are typically 1 inch in length, but commonly incisions are connected for good cosmetic
closure and to ensure good healing. For a one level minimally invasive fusion, two parallel 3cm incisions are placed
about 3-4cm off the midline of the back. The muscles are dilated to an opening about the size of a quarter. At this
time, a microscope is brought in and the decompression of the stenotic region is completed using a high speed drill
and cutting instruments. Once decompression is completed, pedicle screws are inserted one on each side of the
vertebrae and at all levels involved. The screws are connected by a small rod and secured in place. Occasionally,
additional small stab incisions are required to place the rods between the screw heads without causing further tissue
trauma. Bone which is salvaged from the decompression is broken up into small pieces. This bone is added to
bone substitute media and placed along the outer aspect of the screws and rods. This will eventually form a solid
bone fusion. Depending upon the nature of the surgery, structural plastic cages, filled the pieces of the patient’s
own bone, bone substitute media and bone growth promoting protein, are positioned to replace the disc material
between the vertebral bodies to provide additional surface for fusion. The muscle and tissue are closed with suture.
The skin is then typically closed with sutures placed underneath the skin and covered with an adhesive dressing.
Generally you will be in the hospital from 1 to 2 days in order to increase your activity, to teach you care of the
incision & home activities, and to adjust your pain medication before discharging you home. Rehabilitation may be
involved to assist with teaching you post-operative back education and assess any need for placement in an acute
rehabilitation program, if indicated. Home health may be assigned to help you at home for safety evaluation,
equipment, and ongoing education needs.
Please bring comfortable clothing to wear, pajamas of your choice, and shoes for walking on the unit. You may
dress the next day as tolerated. You will be able to shower the second day following surgery. The dressing will be
changed as needed in the hospital and can be removed in 3 to 4 days at home. If steri-strips are placed, they may
be removed in 14 days. You may shower as usual, but avoid direct water pressure on the incision area. Some
incisions may drain for up to 5 days and ranges from bloody to pink-tinged drainage. If the incision continues to
drain longer or the character of the fluid changes with the wound becoming red or swollen, then call the office for
Activity is as you tolerate. Light activity around the house for the first few days; then set about a walking program
daily. Start slow and increase the distance on a weekly basis. Be consistent with activity throughout the week.
Lifting, pushing, pulling is restricted to 5-10 lbs for the 2-4 weeks. The muscles will be sore for the first 2-3 weeks.
Physical Therapy is recommended on a case-by-case evaluation. Walking is the main plan for exercise recovery
and this can be done on a treadmill as well. Start low and increase the time and distance as you tolerate.
Consistency is the best for your recovery. Participation and resuming sports and exercise programs should be
addressed during your follow-up appointments. A fusion will not interfere with your long term plans to return to your
normal activity or participation in sports. Each case is individually evaluated. Driving can generally be resumed
after 1 week.
Use an ice pack to the incision 45 minutes every 4 hours for the first 72 hours. You may use ice or heat to the
muscles around the back, and you may use Ben Gay or Icy Hot type products as well when the incision is well
healed. You can expect to have some discomfort in the back and legs as you increase activity. Cramping of the
back and legs is common for several weeks.
You may be placed in a brace after surgery. The brace is to be worn when out of bed at all times except for
showering. Plan to be in the brace for the next 8 to 12 weeks. Brace fit is important and you can contact the brace
company to ensure proper fit. If the brace rubs or irritates the incision, remove the brace and contact the brace
representative or call our office.
You will have a narcotic medication for pain and may also have a muscle relaxant. Anti-inflammatory medication
such as ibuprofen or Aleve should be avoided as these can interfere with the bone fusion. The medication will be
weaned over the following weeks as you increase your activity and decreased pain is attained. You should not
require long-term pain medication. To avoid constipation, please drink plenty of fluids, juices, and add stool
softeners and laxatives as needed. Walking helps the bowel function by stimulation.
Smoking cessation information is available at the hospital. Smoking causes progression of degeneration and can
cause problems with interfering with healing of a fusion. Smoking cessation is strongly advised.