Question: Discectomy, spinal fusion, or another procedure?

I have seen an orthopedic surgeon. He wants to do a discectomy for numbness and pain in my left leg, but said that would not help my lower back and buttocks pain because of disc problems at L4-5. I think I'm saying this correctly.

I have scheduled a discogram at his suggestion. I see a possible recommendation for a spinal fusion coming, which I don't want.

No one has suggested IDET or LED. Advice?

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Doctor's Response: Discectomy and surgery depend on the cause of leg pain

It really all depends on your predominant problem. If chronic low back pain is more your problem, then it is reasonable to at least consider a fusion procedure. If you have had acute low back pain that is associated with the disc herniation and the leg pain, then it would be more reasonable to just treat the disc herniation with a microdiscectomy and then proceed with rehabilitation (physical therapy) for the low back pain.

In most cases of acute low back pain, even if there are some degenerative changes on the MRI scan in the disc spaces, microdiscectomy leads to a good to excellent result and a spine fusion is not necessary. Also, a spine fusion surgery can always be done at a later date if rehabilitation fails after the disc surgery.

If you have two degenerated discs they are probably looking at a two level fusion. A two level spine fusion changes the mechanics in the back quite a bit because the L4-L5 level is a major motion segment in the lumbar spine, and fusing it transfers stress to the L3-L4 level.

A microdiscectomy does not change the mechanics in the back, and is designed to alleviate compression on the nerve root and allow it to heal.

The two principal factors you need to consider are whether or not your leg pain is worse than your back pain and if the pain is fairly acute (3-6 months). If both of these are the case, then microdiscectomy is probably more reasonable. If you have more back pain and have had it for years, then spine fusion surgery is possibly a better way to go. IDET will not address the leg pain and would probably be contraindicated if you have any degree of nerve pinching.

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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.