Lumbar Discectomy yes, Lumbar Fusion, maybe.

Lumbar Discectomy yes,  Lumbar Fusion, maybe.

Lumbar Discectomy yes, Lumbar Fusion, maybe.

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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.

 

Citations

  • 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

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Author and Contributor to www.Spine-Health.com – July, 2015

www.Spine-Health.com/author/john-h-shim-md-facs

Chief of Surgery, Mease Countryside and Mease Dunedin Hospitals, Safety Harbor and Dunedin, Florida. 2014-2016.

Orthopaedic Section Chief Mease Countryside Hospital; Safety Harbor, Florida Mease Dunedin Hospital; Dunedin, Florida.2008-2013

Board Member Morton Plant Mease Research Council

Co-Director of Mease Neuro-Ortho Spine Center Mease Dunedin Hospital; Dunedin, Florida.

One of “6 Spine Physicians Ranked #1 on Google” – December 2016

Top Ten Most Liked Spine Surgeons on the Internet – July 2016

2016 Spine Surgeons to Know list – January 2016

2014 Spine Specialists to know list – September 2014

One of Ten Leaders of Certified Spine Programs – December 2011

 

The Best Orthopedics in Tampa

The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.
Outpatient Spine Surgery Considerations. www.Spine-Health.com. January 2016.

What is Spinal Stenosis? www.Spine-Health.com. October 2015.

Surgeon insights on the Changing Landscape of Orthopedic Care. OrthopedicToday. June 2014

Chapter 33: Interspinous Spacers. Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

Chapter 35: Minimally Invasive Percutaneous Lumbar Fusion Technique.Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

March 2010 Minimally Invasive Transforaminal Lumbar Interbody Fusion American Academy of Orthopaedic Surgeons Annual Meeting New Orleans, Louisiana February 2010

February 2010 A Review of Dynamic Stabilization in the Lumbar Spine Selby Spine Symposium; Park City, Utah

November 2009 Lumbar Spinal Stenosis Community Based Lecture; Tampa, Florida

September 2009 Instructor/Proctor Minimally Invasive Lumbar Cadaver Lab; Tampa, Florida

February 2009 New Spinal Technology: Cervical Disc Replacement and Interspinous Spacers. Selby Spine Symposium; Park City, Utah

February 2008 The Degenerative Spine: The Role of Dynamic Lumbar Stablization and Interspinous Spacers Selby Spine Symposium; Park City, Utah

October 2008 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

September 2007 Emerging Technology in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

October 2006 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

May 2005 The Role of Kyphoplasty in the Treatment of Vertebral Compression Fractures Mease Neurosciences Symposium; Clearwater, Florida
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