The painful mechanical instability of the lumbar spine associated with spondylo-listhesis and degenerative disk disease is difficult to manage. Patients experience symptoms associated with compression of the nerve roots and cauda equina. Back pain is usually the primary complaint making it important to differentiate the pain from that caused by musculo-ligamentous strain. It is for this reason that we stress the importance of extensive conservative therapy before considering surgical intervention.

Plain x-ray flexion / extension films may demonstrate movement of one vertebral body over the other as well as reduced disk space height (figs.1&2). A positive diskogram, where injection of radiopaque dye into the affected disk reproduces the patients pain and outlines a fissured or ruptured disk, localizes the level of involvement and is helpful in some cases. While compression may be caused in part by herniation of the disk, diskectomy alone is not effective in providing relief since additional impingement is produced by the reduction in disk space height and abnormal amount of additional movement allowed by the joint.

In Lumbar Interbody Fusion with cages the disk is removed and titanium cages filled with bone are inserted between the vertebral bodies in order to maintain disk space height and fuse the joint, thereby eliminating abnormal movement (figs. 3-6). The cages can be inserted from an anterior approach (through the abdomen) or a posterior one (through the back). Your surgeon will determine the best approach.

Patients are kept in the hospital for 1-2 days after the procedure, and are usually able to return to work in 6-9 months.

Your doctor will provide details of the procedure that is right for you as well as the benefits and risks. He will also provide instructions for your care before and after the procedure.