Posterior Spinal Fusion for Spondylolisthesis

Posterior spinal fusion with instrumentation is also a surgery for spondylolisthesis, which is when one vertebra (spine bone) slips forward on another. Depending on the amount of slippage (high grade versus low grade), your child's surgery could require spinal fusion from the L4 or L5 vertebra to the sacrum. A transforaminal lumbar interbody fusion is sometimes added to the posterior spinal fusion procedure in order to decrease the risk of implant failure.

Overall, these surgical interventions are considered if non-surgical treatment is unsuccessful, if there is continued progression of the slippage, or if your child has progressive back pain or neurologic symptoms. Your surgeon will discuss the options that best fit your child’s needs.

How the procedure works

The spine is operated on through an incision made on the lower back.

• Instrumentation, consisting of rods with screws, are placed into the vertebrae of the spine to stabilize the spine. Sometimes an interbody fusion spacer is inserted into the disc space to allow for better positioning and greater surface area for fusion of the spine. With spondylolisthesis, complete reduction of the deformity is not always the goal as much as to restore spinal balance, decompress nerves if needed and improve symptoms.
• Bone graft, which consists of chips of bone, is then placed along the spine. Bone graft is typically obtained from the bone bank, but occasionally may be obtained from the patient’s own pelvis bone.

The rods and screws hold the spine in its corrected position until the bone graft becomes solid. Typically, the instrumentation is left in place after the fusion is complete. This usually takes about 12 months for the fusion to fully heal.

Your surgeon will discuss what limitations of activity they would like for your child to follow once surgery has been completed. Bracing can be used after surgery, but not always.

What to expect with surgery

A posterior spinal fusion is a long complex surgery and not without risks.

• Time: The surgery typically takes approximately 5-6 hours for an otherwise healthy young person.
• Blood transfusions: Some children will require blood transfusions during and sometimes after the surgery. Your surgeon will discuss your child’s risk of needing a blood transfusion at their preoperative discussion.
• Spinal cord monitoring:  Most children have neuromonitoring throughout the operation by a staff member specially trained in this technique. This surgery does have a higher risk of injury to the L5 nerve root due to the location of the procedure. All nerves are monitored closely by our staff to know if there are any adjustments that need to be made during the procedure.
• Infection prevention: Your child will receive many interventions to cut down on the risk of infection, and they will be discussed with you during your preoperative appointment.
  • You will be provided with a prescription for a strong antibiotic ointment (Mupirocin) that you will place in your child’s nostrils and along their future incision site (usually down the middle of their back) for 5 days before surgery.
  • Additionally, your surgical team will instruct you on the use of chlorhexidine wipes prior to surgery as well. These will be provided for you by your spine team.
  • During the surgery, your child will receive high-dose antibiotics regularly throughout the case and after it is completed to combat any infection risk as well.
• Pain management: Pain after surgery is controlled and monitored by a special pain management team. Most patients will be on a patient-controlled analgesia machine (pain pump) immediately following surgery, but will transition to taking pain medications by mouth as soon as they can tolerate
• Hospital stay: Total hospitalization time is usually 3-4 days. Intensive care stay is not indicated for this surgery in an otherwise healthy young person. Physical Therapy will come to work with your child in the hospital to get them moving after surgery.

What to expect after surgery

Most patients will be in the hospital for 3-4 days after a posterior spinal fusion. Your child will be discharged once they are eating normally, having bowel movements and having good pain control on medications by mouth.

The main movement limitations for your child will be to avoid bending their trunk more than 90 degrees early on after surgery. Your child will also have lifting restrictions for a limited time.

Once your child is discharged home, they should be able to walk stairs and sleep in their own bed. They will be discharged with pain medication as well. 

Normally, patients are out of school from anywhere between 3-6 weeks. Your Spine Care team can provide a note with clear instructions to facilitate a smooth transition back into their school life. They should not, however, return to gym or sports until cleared by their spine surgeon.