Three weeks ago – August 7th to be exact – I underwent a five-hour spinal fusion surgery where my lumbar vertebrae L2, L3, L4 and L5 were fixed with eight screws and two rods.
The picture above is the simplest way to picture it: the left side shows the problem – a worn-down disc collapsing and pinching a nerve. The right side shows one segment of the fix – the damaged disc is removed and replaced with a small cage or spacer. The cage (which carries with it bone graft material) restores the gap, while screws and a rod lock the two vertebrae in place so they fuse solid over time.
My surgeon was the eminently qualified Prof Jacob Oh, Chief of the Spine Service, National Healthcare Group and President of Singapore Spine Society.
He approached from my left side (that’s the “transforaminal” part), removed the discs, and replaced them with the cages or spacers – the two terms are used interchangeably. Then he turned me on my tummy and used eight screws and two rods to stabilize the area while the bone will eventually fuse lumbar L2, L3, L4 and L5 together.
For those who like a bit more details:
An L2–L5 spinal fusion is a multi-level procedure designed to stabilize four consecutive lumbar vertebrae (L2, L3, L4, and L5) and relieve pressure on pinched nerves.
Vertebral Bodies (L2 to L5): Four individual bone segments stack vertically to form the lower back section of the spine.
Interbody Fusion Cages: Three separate cages are placed into the disc spaces between each set of vertebrae (L2–L3, L3–L4, and L4–L5). These replace damaged or collapsed discs, restore normal height, and allow bone graft material to grow across the levels to fuse them into a single continuous bone structure.
Pedicle Screws: Metallic screws anchor into the side or rear (posterior) of each individual vertebra (L2, L3, L4, and L5).
Fixation Rods: Rigid metal rods connect all pedicle screws vertically along the back of the spine. This hardware locks the vertebrae together to prevent movement while the bone fusion takes place.
Decompressed Nerves: By inserting the cages and lifting the compressed disc spaces, pressure is relieved off the spinal nerves, leaving a clear path along the column.
For those whose mothers still tie their shoelaces for them, below is a very simple diagram:
What prompted this surgery? I have endured back pain for over a decade. Despite trying everything – a keyhole procedure in 2018, spinal injections, nerve ablation, and acupuncture, etc – the spinal canal stenosis clearly demanded a more definitive solution. Turning 70 next year meant the risks would only compound with age, so I decided to bite the bullet.
My confidence was bolstered by a successful hip replacement in 2024 by another brilliant surgeon, Prof Pang Hee Nee, which proved the exceptional skill of the surgeons we have in Singapore. However, the recovery experiences could not have been more different. While hip replacement pain was no small matter, post-op back surgery pain was on an entirely different level – the kind of torment I wouldn’t wish on my worst enemy. After my hip surgery, I was walking that same afternoon and returned home to navigate my bedroom stairs the next day. This time, recovery required five days in the hospital followed by seven days in rehab before doctors deemed it safe for me to go home.
I am thrilled to report that my bandages are off, my incisions have fully healed, I am completely off painkillers, and I am finally pain free!