Fusion surgery for the treatment of lower back pain has been done since the early 1900's. At that time, spine fusion procedures were done to limit the deformity created by tuberculosis infections, and it was found that not only did the fusion procedure limit the deformity, it also reduced the patient's low back pain as well.

Since then, spine fusion procedures have had variable popularity for the treatment of pain from lumbar degenerative disc disease and remain somewhat controversial in the medical community. Surgeons and researchers span the spectrum in terms of their beliefs as to how useful spine fusion surgery is and when and how it should be performed.

  • Some spine surgeons do not believe fusion surgery is at all useful and is never indicated for the treatment of low back pain from lumbar degenerative disc disease.
  • Some spine surgeons are very willing to offer patients a fusion procedure, and some are even willing to do multiple level fusion surgery.

As with most things in medicine, the truth lies somewhere in between the two far ends of the spectrum of beliefs about spine fusion surgery as a treatment for low back pain from degenerative disc disease. In general, when done by a skilled surgeon for a patient with the right indications, spinal fusion surgery is usually an effective treatment that brings significant relief from severe, ongoing low back pain caused by degenerative disc disease.

Each patient has to weigh the risks of a major surgical procedure and a long healing process with the potential benefits. The spine fusion surgery works best for treating one level of the spine, although two levels can be fused if the patient has severe low back pain. As the number of levels fused increases, the risks of the procedure increase (e.g. a nonunion) and the potential benefits decrease. Only rarely and in extreme cases would most spine surgeons recommend or even offer a three or four-level spine fusion surgery.

Dr. Paul McAfee is an orthopedic surgeon and Chief of Spine Surgery at the University of Maryland St. Joseph Medical Center and at Towson Orthopaedic Associates in Baltimore, MD. He specializes in cervical spine conditions and has been a practicing spine surgeon for more than 30 years.