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Is a Spinal Fusion Commonly Given During Surgery for Herniated Disc?

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Updated June 12, 2014

Question: Is a Spinal Fusion Commonly Given During Surgery for Herniated Disc?
Some doctors routinely give a spinal fusion to their discectomy patients. But is it always necessary?
Answer:

Generally you will not automatically be given a spinal fusion when you have surgery for herniated disc. The reason is that so far, at least, research doesn't support the benefit to you as a patient of a discectomy with fusion. Because of conflicting study results, experts figure that the added cost and potential for related health problems just isn’t worth it, so they refrain from recommending it to the surgeons who follow their guidelines.

As with anything in life, there are exceptions, of course. If you are found to have spinal instability along with your herniated disc, research shows that the fusion may be valuable. But the fact is, most people going into surgery for a herniated disc don’t have spinal instability. Only about 5% of patients do.

Another instance in which spinal fusion may be beneficial when you have a discectomy is if you are an athlete or a manual laborer. Active people may well be able to return to physically demanding work more quickly, maintain it better, and avoid lumbar fatigue (when muscles of your back get tired) if they have the fusion with their discectomy.

If this will not be your first disc surgery, the fusion may be helpful here as well. Research comparing reoperations (having the first surgery redone) with and without fusion found that both were helpful in relieving pain and improving function. But the only time a fusion is definitively recommended with discectomy is when a second surgery is being done in the same area because your disc problems have returned, along with an associated deformity, instability and/or the presence of chronic low back pain.

Should you Have the Artificial Disc Replacement Instead?
Artificial disc replacement is a new procedure that seeks to relieve pain and restore motion between affected vertebrae by replacing a damaged intervertebral disc with a prosthesis. This is a new surgery, and as such, not all the questions about it have been answered. And most of the time, considering artificial disc replacement will only be appropriate if your problem is disc related, as is the case with degenerative disc disease, and herniated disc. If you wish to consider artificial disc replacement, not only should you consult with your doctor, but also research thoroughly the pros and cons of this new surgery.

Source:

DANIEL K. RESNICK, M.D., TANVIR F. CHOUDHRI, M.D., ANDREW T. DAILEY, M.D., MICHAEL W. GROFF, M.D., LARRY KHOO, M.D., PAUL G. MATZ, M.D., PRAVEEN MUMMANENI, M.D., WILLIAM C. WATTERS III, M.D., JEFFREY WANG, M.D., BEVERLY C. WALTERS, M.D., M.P.H., AND MARK N. HADLEY, M.D. Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 8: lumbar fusion for disc herniation and radiculopathy. J Neurosurg: Spine 2:673–678, 2005.

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