Why is fusion poor for back pain/good radiculopathy?

[ans]

I had a positive discogram for L5-S1 years ago. I'm considering a multi-level fusion but do not understand why fusion sucks for back pain. Naturally I know nothing about the surgery but does this have to do with torn annulus' that are pain generators?

Thank you in advance.

ans

[Maria]

Luck of the draw..and probably oh so many little interbody complexities. Sure wish spine surgery was as predictable as other areas of the bod. Oh those nasty nerves..ok slap me as this isn't what you want to know. You want the scientific reason for which we turn to our resident experts (either patients or practitioners). I'm waiting to hear the answer as well.

[dshobbies]

Allan,

I believe there are two reasons why fusion isn't the best course of action, especially for multi-level. Doing research prior to my 3 level, I discovered that fusing them was actually contra-indicated. The entire disc is removed and replaced by bone fragments surrounded by a cage, held in place with screws, to hold the fragments in place until it becomes solid. The two vertabrae 'fuse' together to form one solid bone.

The first and most obvious reason is restricted movement. You probably wouldn't miss the movement from S1/L5 but L4/5 is a different story. Add any additional levels to that and there's the possibility that climbing stairs would be difficult or even impossible... worst case scenario but you'd probably notice your movements were more limited.

Then, the remaining discs, especially those adjacent on top and/or bottom must take on the burden of movement from the fused ones, weakening their structure with the likilhood that they too will herniate... and DDD crawls up or down your spine.

Also, there is the possibility that over time, the hardware needed loosens and causes its own set of problems.

I know two people with single level fusions who are completely happy with their decisions. I know another woman who is completely disabled. Her doctor insists there's nothing wrong but hasn't ordered an x-ray or MRI in 2 years. Her pain is very possibily related to her hardware but without investigative tests, there's no way to know. I advised her to seek another opinion.

So ADRs are seemingly a better way to go. But also, as you know, these also have their own contra-indications, possible side effects and failures. I've often said that the best course of action starts with very skilled doctors. But you already know that.

Happy whatever, Dale

[Maria]

Of course I agree with what Dale has stated however I myself have waited so long to do anything that my facets are now showing degeneration that is supposedly contraindicated with ADR or so my OSS said on my last lumbar xray. Of course L5S1 has autofused so I don't see any reason to undo what has been naturally done and try to give the area more ROM when I think it feels better with less (the change I've noticed over the last few years).

So currently I have a disrupted L3 with anular tear and L4 is a definate pain generator on discogram (L5 was the worst previously). Seems like my current choice based on what my OSS stated would be a 2 level fusion at the very least. Someone else (other surgeon here or abroad) may have a different opinion.. not sure. I think I'd like to see the guy in La Jolla again (the Neurosurgeon) if I were thinking multi level fusion.

I just can't imagine myself having less pain with fusion tho then again I have 2previous back surgery probs which you do not have allan and at least this much could bode in your favor if nothing else.

re fusion being good for radiculopathy tho not for low back pain perhaps it has to do with cleaning up around the involved nerves and freeing them up re radiculopathy but then creating a more fixed limiting ROM for the lumbar spine plus and creating that domino sort of effect re next level up having to handle/accomodate new ROM adaptations, weight bearing load of existing discs and *stuff* like that.

What contributions have the Euro docs given you ans or is multi level fusion your only option to date?

[ans]

I'm not an ADR candidate due to facets.

My pain mgt. doc at UCLA said re: my pain that "this is as good as it's going to get"; I did not ask if he was thinking re: post-surgery.

But I'm thinking of articles I have read that say fusion is better for radicular pain than for discogram-confirmed spine pain. I don't get it but appreciate "stabs" (no pun)/hypotheses.

This may seem incredibly stupid but is the entire annulus taken out for the fused level? Hmm, maybe one problem is that (I"m reading Filler's book) it's damned difficult to understand all pain generators.

Thanks gang.

ans

[Maria]

Nobody can say for sure what's going to happen if we have surgery altho they can say what will happen if we don't in terms of degenerative changes tho not even with regard to pain. The body does what it does. That's my take on it.

Hopefully if surgery is warrented and the surgeon thinks there's a good chance of repairing something or making it better that's the goal. Most of us want pain relief as that's when we decide it's time to do something or when we are tired of not functioning the way we think we should be.

Again~ do the best you can with your research and weigh your options and then choose as wisely as you think you're able.

I chose PM for a pretty long haul now because the post surgery pain I had was so truly horrific for so long post 2nd surgery and I've been much more functional than I was for a long long time. Medicated~ yes.. tho more stable with overall spinal stuff. At least for the present. If there were big changes and much more pain or dramatic pain that I couldn't control with the meds I would probably very much consider surgery. I definately am not closing my door to that option even if it is fusion.

Good luck. I know you're struggling with this decision altho I hope your consultations will give you good explanations that answer your questions.

Then do what you think is right or what you think you need to do. Oh yes editing to add I'd be interested to hear what your consultations have to say and if you've seen Dr.Dillon yet. Perhaps you told me and I've forgotten. So much Cinderella work here..