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Spine and Back Health

Fusion

01/23/2008

Question:

My Ortho. doctor has recommended fusion at L5-S1,L4-L5. I don`t want to have it done at this time. What are the symptoms other than pain that I should have it done. Fusion due to severe DDD, stenosis. 45yr. old male. Too young for this at this time. By not getting it done sooner than later what are the negatives?

Answer:

Hello, thank you for your question. There are, of course, many factors involved in determining whether a fusion operation is right for you. In general, a fusion operation for DDD and pain only is never "necessary", in the sense that it represents one possible treatment option. More concerning symptoms would include severe numbness, tingling, and any significant weakness in the legs. Incontinence (inability to control) of urine or stool would be extreme (and extremely unlikely) findings that would also indicate a more urgent need to have the problem corrected promptly. Fusions can often (but not always) provide good relief of back pain from DDD but should only be considered in light of the risks vs. the benefits. If your pain is not too severe, and you aren't having the types of symptoms I described above, you can choose to wait to have surgery. There are numerous alternatives these days to treat DDD and back pain that don't require fusion, such as artificial disc replacements (so-called "total disc arthroplasty"), or newer dynamic stabilization devices, but not everyone is a candidate for these technologies. Many fusions can also be done minimally invasively (through very small incisions, kind of similar to endoscopic surgery) now. The primary downsides to waiting are that being in chronic pain for a long time can do very nasty things to people - depression, anxiety, irritability, poor sleep, poor appetite, and eventually an untreatable chronic pain syndrome, or even narcotic dependence or addiction. Of course, these things don't happen to everyone. Another downside is that as the disc degenerates more and more over time, the surgery can become more difficult and/or have a lower chance of success. This is only a possibility, though. If you also have stenosis, that can also get worse over time, and if you wait long enough while having symptoms of leg pain, numbness, tingling, or weakness there is a possibility of permanent nerve damage. 45 is fairly young, but it's not necessarily "too young". If your symptoms are severe, you have tried (and failed to get relief from) all the usual non-surgical treatments (physical therapy, anti-inflammatory medications, steroid injections, etc.), and you can't function the way things are, surgery is reasonable to consider. In the end, it's your decision. Good luck. I hope this helps.

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Response by:

David J Hart, MD David J Hart, MD
Associate Professor of Neurosurgery
School of Medicine
Case Western Reserve University