When Should a Spinal Fusion Be Added to a Spinal Lumbar Discectomy Surgery?

A spinal discectomy surgery in America is a very common procedure. The risks of the procedure are fairly low compared with the benefit. Granted, there is a risk of infection, bleeding, injury to the nerve being decompressed, etc. but overall with a discectomy spine surgery the risk profile is low and patients benefit dramatically.

Typically the surgery takes around 45 min. and patients go home either same day or next day. When would a surgeon consider doing a fusion of that level and not just a discectomy? Adding a fusion to the surgery increases the potential risks and complications and should not be taken lightly. But there are times when it is a good idea to add it to the procedure.

One of the most common indications for adding fusion is if the patient has had multiple discectomies at the same level. Here is the thought process on that. If the patient has a recurrence of a disc herniation at the same level as having had a previous surgery, the person should have nonoperative treatment pretty much the same as before to try and avoid surgery. This may include epidural injections from a pain management doctor, physical therapy or chiropractic treatment, and medication management. But if this fails, a lumbar disc removal surgery is indicated after 6 to 8 weeks for pain control, especially if the patient is beginning to have muscle weakness such as a foot drop.

When a person has a discectomy surgery, the part of the disk removed does not regenerate. So disc degeneration is the end result. After one discectomy surgery, this is often fairly tolerable by patients and may just lead to mild to moderate back pain on an inconsistent basis. After a 2nd discectomy surgery, often times the patient ends up with severe degenerative disease. If the patient is having a third discectomy surgery, it is a very good idea to include a spinal fusion surgery. This would remove the rest of the disc, and immobilize that segment so that the eventual severe back pain is hopefully avoided.

If a patient is having a first-time lumbar discectomy surgery and the patient has severe disc degeneration with a considerable amount of back pain, simply taking out the small piece of disk that is pushing on a nerve root is only going to help with leg pain. It is not a back pain operation. So the patient has just as much back pain as they do leg pain, along with a severe degenerative disc, it does make sense to consider having a spinal fusion at that level.

This will hopefully address both the person's back pain and leg pain at the same time.

As mentioned, adding a spinal fusion to a discectomy surgery increases the risks. There is hardware involved with screws and rods, and more dissection is necessary to complete the procedure. There are some minimally invasive ways of doing the surgery, however, anyway you look at it it involves more time in the operating room, more blood loss, and increased risks. For this reason it should not be a decision taken lightly.