Pitfalls of Lumbosacral Fixation

• Arthrodesis of the lumbosacral junction means immobilizing vertebrae L7 and S1 with the sole goal of accomplishing their fusion.
• It’s a complicated procedure, which should only be attempted as a last resort.
• It is appropriate in 3 situations: lumbosacral luxation, as an adjunct to a destabilizing decompression surgery, or in cases of mechanical sacral pain which is unresponsive to medical management.
• In the dog, there is no consensus on how best to accomplish lumbosacral arthrodesis. The various surgical techniques proposed result in highly varied stability. None of the proposed techniques has been the subject of a large-scale or long-term study.
• In cases of lumbosacral arthrodesis, lacking an evidence-based surgical technique, it is important at least to avoid the most common pitfalls, in order to avoid their complications. These can be catastrophic.

Pitfall 1: Operating too soon on patients which are only painful!
Most patients with L7S1 joint problems have pain as their only symptom.

This pain may have a mechanical (lumbosacral) or neurological (radiculopathy) cause. In the absence of motor deficit (limping, lack of weight-bearing...) or sphincter deficit (incontinence), and no matter the significance of the neurological structures compressed or the lumbosacral degeneration at work, only after medical management has been exhausted (rest, physiotherapy and anti-inflammatory drugs for at least 3 months) should a surgical solution be entertained.

Vertebral fixation might then be necessary either as an adjunct to surgery to free the nerve root when such surgery is too destabilizing or as a treatment for pain of mechanical origin, whose physiopathology is poorly understood: arthropathy, painful degeneration of the disc, “micro” mobility. [...]