Physiotherapy in North America for Lower Back
Q: I had a disc removed from my lumbar spine but then the back and leg pain started up again. Now they want to do another discectomy AND fuse the spine. Do I really need a fusion? It seems so permanent.
A: Disc degeneration and herniation are common problems leading to surgery to remove part or all of the protruding disc. But back and leg pain from disc problems can come back after surgery.
Recurrent lumbar disc herniation occurs in anywhere from five to 15 per cent of patients. So patients with back and leg pain that goes away after disc removal (a procedure called discectomy) but comes back six months (or more) later are faced with the decision about what to do.
Once an accurate diagnosis has been made, then the patient and surgeon can get down to the business of treatment. Conservative (nonoperative) care is almost always tried first. There's no sense in doing another surgery if antiinflammatory medication, physiotherapy, or steroid injection would take care of the painful symptoms.
Not everyone responds to conservative care. There are some patients who don't get pain relief no matter what is done. The effect on their quality of life and ability to work is such that a second surgery to remove the rest of the offending disc can't be avoided. Anyone with pressure on the nerves causing bowel and bladder changes is a candidate for surgery right away.
For those patients with spinal instability (the vertebrae are shifting back and forth or collapsing), surgery to fuse the segment may be indicated. This type of situation is most likely to develop in patients who have already had more than one disc herniation. The surgeon does what is needed to take pressure off the spinal nerve roots and then uses metal plates, screws, and bone graft material to fuse the segments together.
If you are unsure about the reasons for the surgery or the expected results, it might be a good idea to visit with your surgeon and ask some additional questions. Fusion is permanent and is intended to hold that segment still during spinal motions. As with any surgical procedure, there are some risks involved. You'll want to head into surgery with a clear idea of the intended effects and possible complications.
Reference: Joseph K. Lee, MD, et al. Recurrent Lumbar Disk Herniation. In Journal of the American Academy of Orthopaedic Surgeons. June 2010. Vol. 18. No. 6. Pp. 327-337.