Back Surgery and Neck Surgery
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July 8, 2008 - 3:25pm
Indications for doing the different types of back surgeries
Can someone explain to me the reasons for getting lumbar fusion vs. laminectomy, microdiscetomy.....and the rest. I have 3 levels of bulging disks, stenosis, and arthritis and I am on my last ditch effort tomorrow. I am getting my 2nd epidural. I already had the facet joint injections and tons of PT. I am still horrible. I think I will probably end up with surgry. I want to understand the reasons (basically) for doing these different procedures. I am so confused!
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You should probably ask this backwards:what is the reason getting the rest vs. spinal fusion.Fusion is the most invasive and it is irreversible.
I have a Q for you:What is causing your stenosis?Is it a central canal stenosis or foraminal?Have you tried a course of steroid treatment?Not epidurals,but oral steroids.
10 yrs of back pain,MicroD at L4/5,12/22/07.Spinal infection post op,still recovering.Bulging discs L2/3/4;Central protrusion at L5/S1.Other than those,no complaints from life,or whatever is left from it....
There's someone in my head,but it's not me...
I have bilateral neural foraminal stenosis and mild central canal stenosis at L3-L4 and also L4-L5. At L5-S1 I have the mild bilateral neural foraminal stenosis but not the central canal stenosis. Bulging disk at those 3 levels and also arthritis.
There are many reasons doctors suggest different surgeries for some of the seemingly similar problems. Every patient is different and many of them not suitable candidate for for one type of surgery or another, based on their past surgeries, age, physical condition, etc. Also, some doctors have their own preferred methods, especially when they are using certain criteria to evaluate their patients. So it pays to consult different type of spine specialists, either orthopedic surgeons or neurosurgeons, I think they have some biases regarding the type of procedure they are most comfortable with.
It also help to educate yourself, read everything you find on your type of spine problems, and if necessary, discuss you options with an outside physician, say your PCP. It is equally important to do a thorough research on the surgeons you are considering, you want to be sure you select the best for your type of surgery.
It is a lot of work, but is worth it.
Good luck in your quest,
Kin
SF Peninsula CA resident
Decompression and L3-S1 fusion with instrumentation, 5/1/08
as above but here is a really general explanation
discectomies and laminectomies are usually indicated for predominately leg pain (sciatica) due to nerve compression(often disc or bone that can be trimmed) rather than back pain, they basically increase the size of the foramina (hole) so that the nerves are no longer compressed as they leave the spinal canal.
fusions are usually indicated for discogenic back pain or back pain due to instability. in some cases a surgeon may jump straight to fusion with only sciatica as they may not be able to decompress the foramina without destabilising the segment. fusions are also indicated for stabilising symptomatic spondylolisthesis too.