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Is a Fusion Necessary with Decompression

Hello,

This is my first time posting but hopefully you can help. I have a bulging disk pressing on a nerve in my L5-S1 with disk space narrowing. My surgeon wants to do a Laminectomy  and Discectomy to decompress the nerve. He also wants to do a interbody fusion with rods to lock everything in place. My insurance is approving the decompression but not the Fusion. They are denying the fusion based on the fact that there is no evidence of instability in that section of the spine. My doctors logic is that if he removes the facet joints but does not do the fusion I will eventually have instability which will lead to a fusion down the road and another surgery. I see both sides of the coin. The insurance does not want to approve something that there is no evince to support and no documentation that instability will happen. My doctor, from experience, feels it will happen and I will need another surgery so we should just try to do it all now. Do any of you know where I can find evidence to lead me in the right direction? Should I fight for the fusion or just go with the decompression and hope I don't get instability? If anyone has dealt with this I would appreciate your insight.
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Comments

  • hvillshhvills Suzhou, ChinaPosts: 971
    edited 09/03/2016 - 7:38 PM

    Bruce

    That's not an easy call... probably both the insurance and your doctor are right.  You might want to discuss with your doctor the possibility of having only a discectomy as a means of relieving your nerve compression/pain.  Another option is to have only a partial laminectomy so as to help try and preserve stability of your spine.  Fusion is quite a bit more invasive versus just a discectomy.... you might want to discuss your options with your doctor or even get a second opinion.

    Harry - 65 year old male...
    PLIF L4-L5-S1 due to disc degeneration... May 23, 2013
    PLIF L5-S1 due to failed fusion and broken screw... Jan 19, 2015
    Microdiscectomy, decompression L3-L4 due to herniated disc... Jan 19, 2015
  • Ellen625EEllen625 New Jersey, USPosts: 757
    Hi
    I had a microdiscectomy and laminectomy at the same spot, L5S1. It relieved all of my pain. I, personally, would not want a fusion unless absolutely necessary.  As hvills said, a fusion is more invasive, longer recovery, etc. Perhaps you can get a second opinion.
    Good luck!
    Ellen 
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  • SavageSavage United StatesPosts: 7,385
    hello mixtajones !
    welcome to spine-health
    please click on link for helpful information!
    Sue
    Honorary Spine-Health Moderator
    -------------------------------------------------------------------------------------------------------------------------
    Please read my medical history at: Medical History

  • hbguru123hhbguru123 BEDFORD, ENGLAND, UKPosts: 15
    Hi. Get a second opinion immediately . If he diagnose something different or other action - ask him how many of this procedure he completed avd the success rate etc
    Then go with you gut feeling . Your doctor most probably correct . 
    Good luck 

    I due to have fusion in ten days and it may not happen as she upset I got 2nd opinion .. 
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