You are in significant pain, and the Doctors determined that your back and leg pain is caused by a Lumbar Disc Herniation. Despite all the non surgical treatments such as medications, therapy, activity restrictions, and injections, you are not getting better and now want a surgical solution. If your Surgeon recommends a surgery, you should be informed about how the recommendation was made.
Usually, the discussion comes down to two things:
1. Removing the disc herniation and taking pressure off your pinched nerve. For those with predominantly leg pain, this is usually a standard part of the discussion. No matter what it is called, (laminectomy, discectomy, laminotomy, foraminotomy, endoscopic discectomy, laser discectomy, etc) the goals should be the same. The disc piece irritating the nerve should be removed, thereby decreasing the irritation of the nerves, and reducing the pain, and discomfort. If this is achieved, there should be a greater than 90% chance of a successful outcome. Most Surgeons will also have this procedure on themselves. I would have this procedure on MYSELF. It is a YES. The complication rates are relatively low, and the recovery is usually very quick.
2. Some Spine Surgeons will also recommend a Lumbar Fusion Procedure along with the Lumbar Discectomy. The reason to have a lumbar fusion is not as clear cut. If there is definite evidence of an instability (the spine bones are moving abnormally on top of each other), then a Lumbar Fusion is probably a reasonable choice. A Fusion is a process by which the body is fooled into thinking two or more separate bones are broken. The body will then heal the “Broken” pieces together to make it one bone. When there is instability, the excess movement, in combination of the disc herniation and bone spurs will cause severe pain with certain movements. Fusion does make sense in this scenario. On the other hand, some Surgeons recommend fusions if there is a central disc herniation at L4-L5, or evidence of arthritis to the back of the spine, or if there is a significant back pain component to the herniated disc.
When polling surgeons, most will say MAYBE to Lumbar Spinal Fusion, and some will even say NO.
Unfortunately, Lumbar Spinal Fusion surgery is less predictable, with higher rates of dissatisfaction. If you are considering Lumbar Spinal Fusion surgery, please ask the Surgeon if they would make the same recommendation on themselves or close family members. For gross instability, tumors, bad fractures, and multiple recurrent disc herniations, it may be the only answer. For other situations, there may be other alternatives.
- Jalalpour K, Neumann P, Johansson C, Hedlund R. A Randomized Controlled Trial Comparing Transforaminal Lumbar Interbody Fusion and Uninstrumented Posterolateral Fusion in the Degenerative Lumbar Spine. Global Spine J. 2015 Aug;5(4):322-8. PubMed PMID: 26225282