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second surgery... discectomy or fusion???

zaza7501zzaza7501 Posts: 9
edited 06/11/2012 - 7:55 AM in Back Surgery and Neck Surgery
I'm new, I've been reading posts and getting info from this site for months, but never posted anything...
I had L5-S1 discectomy on May 24. Was feeling great for 5 weeks, then started having sciatica pain again. Had another MRI and it is re-herniated.
I guess my question is... Would you get another discectomy, or go for the fusion? My surgeon told me that it's my choice, he has no preference. L3/L4 and L4/5 are also worn with slight tears... I am worried that the fusion will put more stress on those discs... but I am also worried that the discectomy won't work again....
Thanks for any advise or input!


  • jlrfryejjlrfrye ohioPosts: 1,111
    I had surgery on the same disc but mine re-herniated in about 3 weeks. I can remember telling my surgeon it re-herniated and he told me it was impossible, after a little argument he sent me for a MRI. Guess what I was right. I also had the same options that you have been given and I chose the discectomy again. That was about 5 years ago and I am now in need of a fusion but at the time I think it was the right choice for me. I am getting relief in other ways for my back trying to put off the fusion for as long as I can. It is a tough decision you have to make and if it helps at all I dont regret my decision one bit for the second discectomy. Keep us posted
  • Zaza, I had a fusion on July 5th, after a failed discectomy on Dec 27th. So far I am recovering OK, but have a lot of sciatica pain. My Dr says that this is because the nerves are basically waking back up. He gave me the option to having another discectomy, or having the fusion. Although my recovery will be a lot longer then what it was from the discectomy, the fusion seems to be the best route for me. No Dr will tell you that this is 100% effective, as it all depends on your body, and how well the fusion takes. Why take the chance in having the same surgery again to fix something that should have been fixed the first time, when there is the possibility of it not working again and you being faced with another surgery, but this time no option. I have always believed in getting it done right the first time, and if not for workman's comp, I would have went straight to the fusion, and not been out of work for a year and a half.

    Good luck on what ever you decide. The ultimate choice is yours, and only you know your body well enough to determine what it can and cannot be put through.
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  • Thanks for the input, I still haven't made a decision. I was thinking of getting a second opinion, but I have a feeling they will say the same thing so what is the point?
    I have been reading up on the fusion surgery and was wondering.... Do they alway put the screws and pins in when they do a fusion? I guess I didn't think it was that involved.... And is it more common to go in through the front or back?
  • I believe the chance of reherniation is about 20% or so on a revision surgery. That means it has lasting success 80% of the time. I personally would not want to change the mechanics of my lumbar spine unless it's absolutely the only option.
  • Going through a lot of the same choices now, but nothing is imminent yet. One thing I would ask the doc would be on the impact on the adjacent disks. Generally, once something is fused, the neighboring disks inherit the function of the fused one(s).

    Have you discussed options other than fusion? For example my doc suggested possibly using a spacer at my L5 - S1 (and maybe other areas) when the time comes.

    As to your question about hardware, yes there is always some type of hardware involved with a fusion. As for front or back insertion of the hardware I can not say for the lumbar region (yet). I think a lot depends on the doc's preferences, and the type of hardware they are going to use.

    For my cervical fusion the doc went in through the front.

    Best of luck to you

    View my history for all the gory details.
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  • I think the revision is the way to go at this point... I am going to get a second opinion hopefully in the next week.
    My surgeon said that the fusion would put pressure on the other discs also (L3/4 and L4/5), which are not healthy...
    This is my first problem with my back and I can't believe how much some people have gone through. These are very hard decisions.... very glad that I found this site...
  • I was going to suggest a second or third opinion. I think that is an excellent idea.

    I was never a real candidate for discetomy but I had a choice of single level or double level fusion (I was unstable with retrololisthis 75% L5/S1). We went with the double since the level L4/5 was already torn and degenerated. My NS said I would likely need that level fused in the next 5-10 years.

    Good luck with the second opinion.

  • I am a 32 year old male who was faced with the same choice about a year ago. I had the first disectomy in Sept 2009 and really never got much relief (maybe 30% better). I went back to the same neurosurgeon who only gave me the option of fusion with hardware. I saw a new surgeon who felt that fusion was not an option for me. He said my options were 2nd dissectomy or do nothing. If the 2nd dissectomy does not last he wants to do the pain pump deal. So in Dec 2010 I had the 2nd dissectomy. The surgeon said he found pieces of disc under my sciatic nerve which was missed during the first "messy" surgery. My disc ruptured at the time of the first surgery. The doctor felt the 2nd surgery was a complete success but it took me awhile to agree. I am happy with the choice I made and am probably 70 - 80% pain free. I have some permanent nerve damage causing constant mild pain in my right ankle foot area. I'm not playing sports anymore, but I can still workout pretty good at the gym and pain no longer controls my life. I still stretch and ice almost daily. I'm still taking ibuprofren and vicadin, but that's nothing compared to the narcotics I relied on for 2 years. Good luck with your decision and God bless.
  • I had the same decision a year ago.
    I opted for the revision microdiscectomy.

    It's a very personal decision but my reasoning?
    A fusion was permanent...last resort. If I opted for fusion and things went wrong, I would be mad at myself for not trying a more conservative route.

    I had a long conversation with my surgeon about what we would monitor to determine if the revision failed. This all had me comfortable that I had a plan.

    My goal & my surgeon...try the revision b/c I re-herniated within the 3-month period where it tends to happen. Actually within a few weeks most likely. It was pretty clear that scar tissue and another large piece of disc was causing my issues. My rationale was that if I could buy myself even a few years...technology migh change and give me even more options. And if not, the fusion was still there.

    Good luck.

  • Thank you! I have my appt with my second opinion surgeon tomorrow afternoon! I really hope that he can help me figure this out... My pain has actually gotten a little better since my last post, but still not acceptable to me...
    I just really don't want surgery again! My son is in football 4-5 days a week and I don't want to miss that, but my insurance renews oct 1 so new deductible... Hmmm... Choices...
    Any opinions on cortisone injections? For buying some time?
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