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2nd laminectomy surgery vs. fusion??

Looking for some answers and am hopeful this forum will be helpful. In late September of 2012 I had laminectomy surgery L4/L5 which I felt was a tremendous success. I was almost 100% pain-free for the first time in many years. However, 3 months later I have blown that disc out again. The surgeon feels the same surgery would be problematic and is recommending a full fusion. I've tried researching the issue and am not finding significant information. I would appreciate it very much if someone could share their experiences/thoughts with me. My pain level is high and I feel I need to do something here soon, but I don't know enough about the fusion process/success rate to make a decision. I am an active adult male, 52 years old, in general good health. Thanks in advance for your feedback.


  • Could you ask your surgeon to explain his reasoning for suggesting a fusion?
    I know that often surgeons will suggest a fusion after a couple of discectomies for problematic discs.

    A fusion changes the spine and it will never be the same again. It is possible that after a fusion, there may be more stress put on the adjacent levels which will cause a need for more surgery in the future.
    When needed though, a fusion can really help and reduce the pain levels and enable people to get back to a more active and comfortable life. People with spine problems that need a fusion are likely to continue to have some sort of back problems for the rest of their life, although hopefully much better than before surgery. Also be aware that the recovery from a fusion is very long.

    If your life is being restricted by your pain levels and your surgeon has a good reason for why he feels a fusion is necessary, then it might be the way to get your life back. I would suggest a second opinion before making the decision for a fusion though.

    There are some very good and informative articles on this site about lumbar fusions. I would suggest that you learn as much as you can, write a list of questions and see your surgeon again to ask him to explain his reasoning. Then try to get at least one more opinion. If both surgeons agree, then you can decide what you want to do, being fully informed on what the recovery is like.

    Do let us know how you get on and what you decide. :-)
  • I had Microdiscectomy that really provided no relief and found out I had herniated again (or a piece was left behind).
    I agree, I would ask why the fusion? I would also ask if he minds if you get a 2nd opinion (he shouldn't mind at all).

    In my case, the surgeon told me 2nd micro-discectomy but encouraged me to get a 2nd opinion if I wanted. So I did. That surgeon said same thing but he was not in my plan coverage (this was relevant to my decision b/c my initial surgeon was also not in my coverage). So I opted for a 3rd opinion which is where I was told fusion which confused me. I spent several weeks researching and learning. I was 40. In the end, I opted for the revision surgery over the fusion. Why? Because I felt the fusion was permanent and if it didn't work, I'd be out of options and there was no going back from that. I also spoke to many people who had lumbar fusions and most (except for 2) were not happy with the results. I decided to try the revision even though I knew it might set me up for a 3rd surgery and more scar tissue. I worked with my (new) surgeon and we talked at length about my life plan. This helped because I knew that I might need another surgery but I knew what he was going to look for to decide. We also discussed how if he could buy me even 5 years, technology would advance and maybe I'd be a candidate for ADR or another treatment. I'm 3 years out of the 2nd surgery. I was VERY careful on recovery and you can look through my posts because I wasn't sure I had made the right decisions initially b/c I didn't feel different. But 6 months after the 2nd surgery I looked back at how much progress I made and was pleased. I was an extreme disc rupture (lost feeling in most of the back of my left leg and foot, foot drop, loss of strength, weakness, etc.). I'm 3 years out and the last 6 months have been wonderful. I have bits of pain...can't lie but overall, pleased that I went for the revision. I guess I could be talked out of the fusion because of the risks involved vs. my pain vs. my other option.
    I knew if something went wrong in the fusion, I would regret it which is why I didn't go for it.
    I knew if I couldn't be talked out of the fusion, it would have been a good choice for me.

    Hope that helps in the approach.
    Good luck and do let us know what you decide.
  • DNice: great logic. There's no going back after fusion.

    And great that your nerve damage recovered.

    Did you increase your core strength too?

    Keuka: I have seen 3 micro-d's mentioned as the usual max number, if stenosis is not involved, then fusion is often the next step.

    Take care.
  • i had a microdisectomy / laminectomy in june of 2010. re-herniated the disc a week after the surgery. doc wanted to do a revision, so basically the same surgery all over again. 4 months later, that's what i had done. i asked about a fusion, since obviously i was prone to herniating discs at that point. and doc said i had plenty of disc material left, and he felt it was a simple fix, the microdisectomy would fix the problem, which was sciatic pain. (plus it turns out i had 85% of my spinal canal blocked by that second herniation. he just didn't tell me that until after the surgery.)

    anyway, it never really helped, my second surgery. 4 months afterward a new MRI showed the disc had herniated again. seems by the time they cleaned it up a second time, the entire back wall of the disc was just gone, and there was no way it would ever heal again. but i was at a point where i could live with the pain, and i didn't want to go through another surgery.

    needless to say in the meantime, i ended up having a 2 level cervical fusion for more herniated discs in my neck. and by february of 2012, the low back pain was so bad, i was begging to get the fusion done. i had the lumbar fusion in june of 2012. 6 months out now, and i'd say things are better than before surgery. but are they good? not really. i'm still in daily pain, but its a lower level, where i can function without the narcotic pain killers most of the time. i can do more, i can stand longer, but i'm not pain free, nor do i think i ever will be.

    i don't know how this can help you really. its just what i went through with my own recurrent herniated disc. i will say though i had 3 surgeons all give me the same opinions for the second and third surgeries. none of them would consider the fusion for the 2nd surgery. they felt it was too soon to do it. (i'm also only 40 now which might have played a role in their determinations.) and i had 2 docs even mention a 3rd microdisectomy to me, until they found the bone spurs on my CT scan. the bone spur couldn't be removed without removing enough of the bone, that a fusion was necessary, and the bone spur was pressing right into the nerve root.

    does your surgeon say why the revision would be problematic?
    Microdisectomy / hemi-laminectomy 6/2010 and revision 10/2010
    Cervical fusion C4-5 and C5-6 9/2011
    Lumbar Fusion L5-S1 6/2012
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