long term side effects of spinal fusion

The hardware may be placed in the front (anterior) or the back (posterior) of the spine. Accessed Nov. 22, 2022. 2022 Oct 11;15:3137-3156. doi: 10.2147/JPR.S375720. Wang J., Dailey A., Mummaneni P., Ghogawala Z., Resnick D., Watters W., Groff M., Choudhri T., Eck J., Sharan A., Dhall S., Kaiser M. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. 2015;16:251. The doctor used live imaging, such as X-rays or ultrasounds, to spot the exact location of the transplant. A blood clot can move through the circulation and end up in the lungs on rare occasions. These treatments are used to restore spine stability, cure spinal deformity (such as scoliosis), and bridge space produced after a spinal decompression procedure by removing a spinal part. "We designed this system because we think no other system fits the true philosophy of how the SI joint should be fused," Dr. Cross says. All Rights Reserved | Website by WP Flare, Spinal fusion is a surgical procedure in which two or more vertebrae are permanently joined. So to summarize, following are some of the most common potential long-term side effects of scoliosis surgery: Nerve damage Back pain Loss of flexibility Limited range of motion Hardware malfunction Adverse reaction to hardware Loss of strength in the spine Strained muscles surrounding the spine A spine that's more prone to injury These issues can arise from arthritis, injury, aging, or disease. I have been a patient with severe pain and know firsthand the limitations of traditional orthopedic surgery. Preoperative adjacent-level disc degeneration, pseudarthrosis, and secondary operations were analyzed. ", Research has established that the SI joint is the source of pain in nearly half of patients who experience new or continued low back pain after fusion surgery. Implant failure, particularly early after back surgery, is a sign of persistent severe spinal instability. Spinal Fusion Surgery: Uses, Procedure, and Recovery - Healthline They had a lumbar arthrodesis at the third lumbar level or below and their operations were performed before 1964. Either way, a metal plate or rods and screws will hold the bones together until the bones heal. This is a real problem, with an incidence of 9% (9). Then the spine might need more surgery in the future. When spinal fusion is performed in the . These treatments are non-invasive and less painful than conventional methods. Ami TR. PRP is rich in growth factors that can increase blood flow and healing. 2013;7:5659. Make a donation. PMC style=font-weight: 400;> After removing a damaged (herniated) disc, spinal fusion may be utilized to stabilize the spine. The long-term effects of spinal fusion on the sacroiliac joints and ilium Ninety-six patients who had lumbar disk excision and primary posterior fusion were studied 10 or more years after their operations. Damage to the spinal cord (about 1 in 10,000) Bleeding, major blood vessel injury. The likelihood of this result becomes even more frequent with fusions of three or more levels. The MRI is a cross-section image. There is the possibility that the surgery is not successful in treating the pain and the symptoms return. Unable to load your collection due to an error, Unable to load your delegates due to an error. Rajakumar DV, Hari A, Krishna M, Konar S, Sharma A. Neurosurg Focus. I am a co-founder of the Centeno-Schultz Clinic which was established in 2005. Chang PY, Chang HK, Wu JC, Huang WC, Fay LY, Tu TH, Wu CL, Cheng H. J Neurosurg Spine. Yes, spinal fusion can cause problems later in life. Additional symptoms experienced by some adults with scoliosis. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Epub 2022 Nov 23. Among the long-term side effects of spinal fusion, there a number of problems that arise as a direct result of lumbar fusion itself. Absolutely! Osteoporosis is a disease that weakens your bones, making them more susceptible to sudden and unexpected fractures. The AAOS indicates that physical activity too soon after surgery can result in pseudarthrosis, which may prompt a second surgery 13. The same forces that can cause the hardware to break can also cause the screws to become loose. The best way to avoid these complications is to avoid spinal fusion surgery. To assess the long-term, >10-year clinical outcomes of anterior cervical discectomy and fusion (ACDF) and to compare outcomes based on primary diagnosis of disc herniation, stenosis or advanced degenerative disc disease (DDD), number of levels treated, and preexisting adjacent level degeneration. See Failed Spinal Fusion Surgery. No bending, lifting, or twisting. This is done to eliminate uncomfortable motion or restore spinal stability. Before your treatment, your doctor will go through all of the risks with you and take particular precautions to assist you to prevent any issues. muscle, ligament, or nerve damage. Patients frequently need to wear a back brace after they leave the hospital to keep their spine in good alignment. VA underwent lumbar fusion several years ago for severe low back pain. If the anterior devices were placed anteriorly (from the front), rather than through a. Patients typically cannot resume routine activities until the bone has fused into place. wound pain. Electrode failure and migration are the most common. Every surgery comes with a risk of complications 2. 2017 May;26(5):577-585. doi: 10.3171/2016.10.SPINE16317. The most common indications for L5 S1 fusion include: Low back disc degeneration Slipped disc ( spondylolisthesis) Spinal Bone Fracture Recurrent Disc Herniation Pain radiating down leg (Sciatica ) Curvature (Scoliosis) Narrowing of the Canal (Stenosis) Failed Spine Surgery with Instability. ACDF leads to significantly improved outcomes for all primary diagnoses and was sustained for >10 years' follow-up. Explore Mayo Clinic studies of tests and procedures to help prevent, detect, treat or manage conditions. Your doctor may recommend that you wear a brace for a time to keep your spine aligned correctly. What is L5 S1 Fusion? and transmitted securely. Reisener MJ, et al. 1991 Jul; 73(6):802-8. https://www.ncbi.nlm.nih.gov/pubmed/2071615/. For procedures that require more bone, like a posterior fusion, the non-union rates are as high as 26-36% (2,3). 1998-2023 Mayo Foundation for Medical Education and Research. 2020; doi:10.21037/jss-20-492. If you follow all your surgeon's instructions, you can expect a smooth spinal fusion recovery that relieves your back pain and any previous numbness or tingling. J Bone Joint Surg Am 1998; 80:941951. National Library of Medicine Some patients with this ailment have no symptoms, while others have back, neck, arm, or leg discomfort. Consider the following results: In one study 53 patients were followed for an average of 20 months after fusion surgery. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. The surgeon uses bone grafts or metal implants to attach the . They list some alternatives, such as: Sarah Pflugradt holds a Master of Science in food science and human nutrition from Colorado State University. The site is secure. Salamanna F, Contartese D, Tschon M, Borsari V, Griffoni C, Gasbarrini A, Fini M. Front Surg. The risks of spine surgery include: damage to a spinal nerve unsuccessful treatment, which can lead to pain that persists after surgery a return of back pain, particularly after spinal. Image illustrates unilateral sacroiliac (SI) fusion procedure using a system that provides a principles-based fusion, maximizing the concepts of joint preparation, compression and stability. Eur Spine J. This functional unit includes discs, facet joints, ligaments, fascia, and muscles. Matg G, Berthold C, Gunness VR, Hana A, Hertel F. J Neurosurg Spine. Summary of background data: Blood clots. Spinal fusion is a major surgery where one or more spinal bones (vertebrae) are fused together using screws, bolts, and or plates. Why would this occur? Inadequate symptom relief after the surgery, Failure of bone graft healing to create a fusion (a non-union, or pseudarthrosis), Temporary or persistent swallowing (medically known as dysphasia), Potential speech disturbance from injury to recurrent laryngeal nerve that supplies the vocal cords, Damage to the spinal cord (about 1 in 10,000). 1992;17(8):940-2. Singleton M, et al. VA underwent lumbar fusion several years ago for severe low back pain. An important long-term experiment compared spinal fusion to physiotherapy over more than a decade seemed to produce a contradictory result that "prevents a strong conclusion.". All statements and opinions are provided for educational and informational purposes only. We view and approach the spine as aFunctional Spinal Unit. Before "But with force transfer after spinal fusion, the SI joints can move a couple of millimeters," he says. Prospective cohort study with >10-year follow-up. Adjacent Segment Disease and injury of spinal muscles are additional complications from fusion surgery. Fusion surgery removes this important shock absorber placing additional stress and forces on the discs and facet joints above and below the level of the fusion. So, l5 s1 surgery success rates would reflect in those statistics. The authors cherry-picked the best possible sounding news from their . Damage to the trachea/esophagus. doi: 10.1371/journal.pone.0149312. Eur Spine J. Spine (Phila Pa 1976). Fusing usually takes about. sharing sensitive information, make sure youre on a federal All 159 consecutive patients had autogenous tricortical iliac crest bone graft and plate instrumentation used. About 3.4% to 10% of people. 7.Ho, S., Kim, S., Ha, S. et al. Spinal fusion may be recommended by your doctor to address the following conditions: Fill out the form below to schedule your FREE virtual consultation. Read More. Anterior Cervical Discectomy and Fusion Complications - Spine-health There are a number of complications arising from L5 S1 fusion. They then can fuse and heal as one bone. To stabilize the spine, screws are placed into the spinal bones above and then below the disc that is removed. In most cases, spinal fusion is a generally safe treatment. It is most usually extracted from your pelvis, leg, or ribs. Spinal Cord Stimulator (SCS): What It Is & Side Effects L5 S1 fusion is major surgery whereby the L5/S1 disc is removed and the L5 and S1 spinal bones are stabilized by hardware. 2018;8(7):722-7. Spinal fusion is a surgical procedure in which two or more vertebrae are permanently joined. Health outcome assessment before and after anterior cervical discectomy and fusion for radiculopathy: a prospective analysis. L5 S1 Fusion refers to the level of the surgery. Fracture types. The procedure employed by the surgeon is determined by the position of the fused vertebrae, the cause for the fusion, and, in certain cases, your overall health and body form. Make a donation. J Spinal Disord Tech 2005; 18:304308. . There are many reasons for this to occur. Lets dig in. The results of the individual surgeon with ACDF surgery (meaning that the frequency of complications varies between surgeons), and; Individual patient risk factors, such as the condition of the disc, the patients physical condition (bone strength, diabetes, etc. The age, overall health, and physical condition of a patient influence how soon they recuperate and return to their normal activities. Why would a lumbar fusion fail? Treatment options include PRP and your own bone marrow-derived stem cells. The result can be motor or sensory loss which might manifest as pain, weakness, desensitized touch, and bowel or bladder problems. These issues are more likely to arise in the first few weeks following surgery. However, spinal fusion, like any surgery comes with some risks. The surgery is joining two bones together, so there is a risk for decreased range of motion, indicates the AAOS, but they note that most patients will not notice a difference. Transforaminal Lumbar Interbody Fusion: Complications, Risks Injury to blood vessels or nerves in and around the spine. Degenerative disc disease, herniated disc, infection, scoliosis, tumors, fractured vertebrae, spinal stenosis, and spondylolithesis are the most common cited back problems that could warrant a spinal fusion 13. Is Minimally Invasive Spine Surgery Right for You? You may be asked to stop taking some medicines for a time before the surgery. What are the Long-Term Side Effects of Spinal Fusion? 2. All rights reserved. Chronic (long-term) pain: A herniated disc, causing nerve damage, is the most common cause of chronic pain after a TLIF. This can lead to additional surgeries including fusions. Smoking, diabetes, and advanced age can also increase the risk of developing pseudarthrosis. Only after your doctor can establish the source of your discomfort will they offer. 2022. This additional force in turn can lead to injury of these facet joints and discs leading to degeneration and arthritis. J Neurosurg Spine. Your doctor uses the two vertebrae on either side of the removed disc to form a bridge (or fusion) across the bone grafts to promote long-term stability. What causes spinal fusion to fail? Surgeons execute spinal fusions while you are under anesthesia, so you are completely unaware of whats going on. Long term results of spinal fusion: good news and bad? 2014;8(3):281-97. Reoperation rate after instrumented posterior lumbar interbody fusion: a report on 1680 cases, Adjacent Segment Disease After Posterior Lumbar Interbody Fusion: A Case Series of 1000 Patients. There is a small plexus of nerves in front of the L5-S1 disc space that helps control ejaculation. Pain at the bone graft site. What are the options to I've developed numbness and tingling in my fingers that gets worse after pushing up hills. This site complies with the HONcode standard for trustworthy health information: verify here. Obtain Long Term Pain Relief. Lumbar spine fusion: what is the evidence. This offers new ways to securely walk, stand, and sit. Twenty-four were not located and 8 were deceased. Spinal headaches - Symptoms and causes - Mayo Clinic Secondary surgeries were performed for pseudarthrosis repair and for symptomatic adjacent-level degeneration. Spinal Stenosis: Symptoms, Causes, Treatment, Exercise, More - Healthline Unauthorized use of these marks is strictly prohibited. This novel, comprehensive approach can help you avoid lumbar fusion and its complications. While the bone graft sets, metal plates, rods, or screws may be used to keep the vertebrae together. What Are The Long Term Effects of Spinal Fusion? Screws are used in lumbar fusion to stabilize the spine. By far the most common complication following surgery is difficulty with swallowing, medically known as dysphagia. The good-news-bad-news conclusion was a bit of an illusion. (2) 2 years after lumbar fusion 40% of patients were unsure/dissatisfied with the outcomes reporting ongoing back pain and limited daily function (3) Another study demonstrated that the overall failure rate of lumbar spine surgery was estimated to be 10%46% (4). PRP and cell-based therapies are promising options for lumbar disc replacement and spinal fusion. This blog will focus exclusively on lumbar fusions. eCollection 2022. "If there's no hardware in or across the SI joint from a previous surgery, a steroid might give some durable pain relief," Dr. Cross says. The patients discharge date is determined by their general health, the physicians procedures, and the patients response to the procedure. Although spinal fusion is a surgical procedure used to stabilize and join two or more vertebrae together, it can still cause issues in the long run. eCollection 2022. Please enable it to take advantage of the complete set of features! Spinal instrumentation, also known as spinal implants, devices, or hardware, involves the implantation of stainless steel, titanium, titanium alloy, or non-metallic items into the spine by surgical procedures. July 2014.. http://www.spine-health.com/search/google/fusion?query=fusion&cx=000920495788068656876%3Ag_h27naqu74&cof=FORID%3A10&sitesearch=. The dysphagia usually resolves within days, but there is a risk that it can last weeks to months. It has been estimated that about of patients will have symptoms from problems at an adjacent disc by 10 years after surgery. The following are some of the potential dangers and problems of spinal fusion: Its critical that you carefully follow your doctors recommendations regarding the warning signs of blood clots and infection. Learn more about the long-term effects of spinal fusion here. Mayo Clinic has developed new techniques for the diagnosis and treatment of patients with SI joint dysfunction. This content does not have an English version. The surgery involves cutting through important muscles, ligaments, and tendons to access the targeted disc. The following are some of the potential dangers and problems of spinal fusion: Infection: To reduce the risk of infection, antibiotics are given to the patient before, during, and after the operation. There is also a chance of developing symptoms at of the disc levels either above or below the fused vertebrae, termed Adjacent Segment Disease (ASD). The long-term side effects of spinal fusion involve non-union, hardware failure, Adjacent Segment Disease, and spinal muscle injury. These synthetic materials aid to increase bone development and accelerating vertebral fusion. These. Spinal instrumentation is a long-term remedy for spinal instability. The disc is named for the two spinal bones it is sandwiched between. Spinal fusion typically works for fixing broken bones, reshaping the spine or making the spine more stable. 2022 Oct 17;9:983931. doi: 10.3389/fsurg.2022.983931. On the right, the yellow arrows point to dark healthy spine muscles that were present prior to the surgery. Spine (Phila Pa 1976) 2000; 25:801803. For example, the lowest disc in the low back is the L5/S1 disc. 1.Deyo RA, Gray DT, Kreuter W, Mirza S, Martin BI. Fusing usually takes about 3 to 6 months. Discuss with your surgeon the risks and benefits of disk replacement surgery compared with more traditional types of cervical spine surgery. Your doctor recommended an L5 S1 surgery. Level of evidence: Patients must stay in the hospital for a period of recuperation and supervision following a spinal fusion. Office hours: 7am 5pm, Knee Hurts When I Bend It and Straighten It, Burning Pain on Outside of Knee When Kneeling, Muscle Pain After Cervical Fusion Surgery, Basal Joint Arthritis or CMC / Carpometacarpal Arthritis, Common Craniocervical Instability Symptoms, Perc-FSU Trusted Alternative to Spinal Fusion, Perc-ACLR - Regenexx Treatment for ACL Tear, Regenexx Non-Surgical Alternative to Cervical Fusion, Perc-CT SR Alternative to Carpal Tunnel Surgery, Non-surgical Disc Bulge or Herniated Disc Treatment, Regenexx Alternative to Ankle Fusion Surgery, Perc-CMC Alternative to CMC Joint Surgery, Spinal fusion in the United States: analysis of trends from 1998 to 2008, Functional results after anterior lumbar fusion at L5-S1 in patients with normal and abnormal MRI scans, Evaluating rehabilitation following lumbar fusion surgery, Failed back surgery syndrome: definition, epidemiology and demographics, Degenerative lumbar spondylolisthesis with spinal stenosis. As with any form of surgery, laminectomy carries a risk of some side effects. Harvard Medical School makes some suggestions for alternatives for spinal fusion, as they indicate spinal fusion is only helpful in approximately 50 percent of patients 134. As a result, spinal hardware might be utilized as an internal splint to keep the spine in place as it heals following surgery. Oct. 4, 2022. If symptoms develop from the same disc level following surgery, it is usually because the bones did not successfully heal togetherwhich is called a nonunion or pseudarthrosis. Pflugradt is a freelance writer and registered dietitian with experience in clinical nutrition and outpatient counseling for diabetes management and weight loss. From the back, it's known as posterior spinal fusion. Avoid strenuous activities of any kind (golfing, tennis, home improvement tasks, etc.). 2008;17(8):11071112. Lumbar fusion involves screws, bolts, and plates that stabilize the spinal bones. Intern Med J. The spinal muscles provide critical stability and support for the spine. Mid- to Long-Term Outcomes of Cervical Disc Arthroplasty versus Anterior Cervical Discectomy and Fusion for Treatment of Symptomatic Cervical Disc Disease: A Systematic Review and Meta-Analysis of Eight Prospective Randomized Controlled Trials. The information is produced and reviewed by over 200 medical professionals with the goal of providing trusted, uniquely informative information for people with painful health conditions. Spinal Cord Stimulator: Uses, Benefits, Side Effects, Precautions Spinal fusion can be used to: Spinal fusion is generally safe. What Are the Long-Term Effects of a Spinal Fusion? | Healthfully 8600 Rockville Pike Therefore, L5 S1 fusion surgery involves the surgical removal of the L5/S1 disc and fusing the L5 and S1 spinal bones together. 11th ed. Treatment options for back pain include PRP and a patients own bone marrow-derived stem cells. Having a spine that doesn't move in places puts more strain on the areas around the fused part. Learn How Bone Growth Therapy Can Help You, Get a Comprehensive Evaluation from Mayo Clinic's Spine Care Experts. The doctor takes these cells from the patients adipose (fat) tissue and bone marrow. Metal plates, screws or rods might hold the bones together. The production of blood clots in the legs is another unusual consequence. 7.Harris IA, Traeger A, Stanford R, Maher CG, Buchbinder R. Lumbar spine fusion: what is the evidence. Clipboard, Search History, and several other advanced features are temporarily unavailable. "The imaging can look normal, and the reliability of common physical exam techniques can be poor. For a few days, many patients may not be able to resume a typical solid food diet. For an ACDF surgery, the main potential risks and complications that tend to occur include: By far the most common complication following surgery is difficulty with swallowing, medically known as dysphagia. Patients typically cannot resume routine activities until the bone has fused into place. Preventing movement helps to prevent pain. Spinal fusion is surgery to connect two or more bones in any part of the spine. BMC Musculoskelet Disord 21, 73 (2020). In the example shown, a damaged disk is removed, a bone graft is inserted, and plates and screws hold the bones together. J Neurosurg Spine. What is a spinal fusion? Patients frequently need to wear a back brace after they leave the hospital to keep their spine in good alignment. These can include: blood loss. https://www.uptodate.com/contents/search. Hardware Longevity and Failure Any medical procedure that depends upon installing foreign and unnatural hardware into the body comes with additional risks and related questions: What type of material is being used? As a result, those areas of the spine might break down faster. Differing presentations of severe sacroiliac joint pain, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Back pain after back surgery: The SI joint and adjacent segment disease. Is cervical disc arthroplasty good for congenital cervical stenosis? The most common risk of any of the modern spine fusion surgery techniques is the failure to relieve lower back pain symptoms following the surgery. // Leaf Group Lifestyle, Complications With an L5-S1 Spinal Fusion, National Institute of Neurological Disorders and Stroke, The AAOS recommends starting physical therapy, The Open Orthopaedics Journal: Risk of Complications in Spine Surgery: A Prospective Study, Harvard Medical School - Harvard Health: Turning Your Back on Back Surgery, NIH: National Institute of Neurological Disorders and Stroke: Low Back Pain Fact Sheet, Wang J., Dailey A., Mummaneni P., Ghogawala Z., Resnick D., Watters W., Groff M., Choudhri T., Eck J., Sharan A., Dhall S., Kaiser M. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. The yellow arrows point to the muscles that were injured and now are dead as a result of the fusion surgery. This functional unit includes discs, facet joints, ligaments, fascia, and muscles. doi: 10.3171/2016.11.FOCUS16412. Infection. 6.Okuda S, Yamashita T, Matsumoto T, et al. The most common risk of any of the modern spine fusion surgery techniques is the failure to relieve lower back pain symptoms following the surgery. How Much Neck Mobility Is Lost After Fusion Surgery? - Spine-health The likelihood of this result becomes even more frequent with fusions of three or more levels. Sometimes, surgery on the spinal bones of the neck occurs from the front. A small minority of patients will have ongoing discomfort at the location of the bone transplant. This affects patients with large and progressive curves (over 70 degrees) that compress the lungs. Spinal fusion often works no better than nonsurgical treatments for back pain with a cause that's not clear. After you go home, contact your doctor if you exhibit signs of infection, such as: It may take several months for the affected bones in your spine to heal and fuse together. Spinal fusion can help address malformations in the spine, such as a lateral curvature (scoliosis). This stresses the importance of good post-operative wound care. Part 8: lumbar fusion for disc herniation and radiculopathy. Mayo Clinic; 2021. This consequence is extremely uncommon. This author has been verfied for credibility and expertise. Youll be laying down with a blood pressure cuff on your arm and a cardiac monitor on your chest during the treatment. Trends in lumbar spinal fusion A literature review. His low back MRI is below and is most significant for the death of the critical low back muscles. Alternatively, the same factors that caused the problems at the disc(s) that required surgery may have ultimately impacted the other discs as well. J Bone Joint Surg Am 1993; 75:12981307. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Katelyn beats scoliosis with new innovative surgery, Mayo Clinic Q and A: Cervical disk replacement, Sharing Mayo Clinic: Complex spine surgery helps Belinda Purdy walk again, Mayo Clinic Q and A: Scoliosis treatment options, Mayo Clinic Minute: When spine surgery is the answer, Mayo Clinic Minute: Scoliosis is not just for kids. The doctor will want to monitor the patients reactions to the anesthetic and operation at first. Unfortunately, after the surgery, the pain never changed. Next Page: The screws are stabilized by additional hardware including plates and rods. Bleeding. Surgery doesn't cure arthritis. The sacroiliac (SI) joint is a common but underrecognized source of continuing back pain in patients who have surgical fusions for the treatment of back pain. Arthritis causes much of back pain. Copyright 2023 Leaf Group Ltd., all rights reserved. while lowering the risks and length of recovery time associated with spinal fusion surgery. Long-term side effects and Infection after Spinal Fusion Surgery Emery SE, Bohlman HH, Bolesta MJ, et al. Young adult hip and pelvic conditions: Comprehensive approach for optimal care. There are significant forces placed on the low back and the hardware. L5 S1 Fusion Surgery: Success Rate & Complications - CSC Patients are taught new methods to move after surgery since their flexibility may be reduced. 2018;48(12):1430-4. Spine Fusion Post-Operative Care, Learn how bone growth stimulation therapy can help your healing process. All can require additional surgery. Nvidia Driver Package Unraid, Articles L