Question: Is it Safe to Have a Fusion?

Over five years ago, I had a discectomy of L4-L5 where the surgeon just cut the bulging disk. About a year ago, I had another discectomy of L4-L5. My surgeon told me that he had completely removed my disc in L4-L5 without a fusion. Currently, if I try to bend forward at all or straighten up, there is intense sharp pain. I didn't feel this way at all after my first surgery.

Is it normal to remove the entire disk without fusing? Also, is it safe to do a fusion now on L4-L5?

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Doctor’s Response: Conservative Treatments, Then Consider Fusion

I would highly doubt that the spine surgeon completely removed the disc. The only way to completely remove the whole disc is to go through an anterior approach through the abdomen, and I would doubt any surgeon would do that without fusing the spine.

It is much more likely that your disc space itself is still painful. If this is the second disc herniation, it may be continuing to degenerate (meaning that you have degenerative disc disease). If you do not improve with conservative treatment, you may in the future benefit from a fusion. Basically, a fusion is designed to stop the motion at a painful motion segment, and in cases of advanced disc space degeneration it can be quite effective.

Generally, it is not advisable to consider a spinal fusion unless the pain is significantly limiting your activities. Otherwise, exercises, including stretching and conditioning, should suffice to control the pain.

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In Spine-health’s Doctor Advice section, physicians respond to frequently asked questions about back pain issues. These responses represent the opinion of one physician, and do not necessarily reflect the views of the broader medical community. The advice presented has not been peer reviewed by Spine-health’s medical advisory board.