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Is Spinal Fusion the Best Treatment for Low Back Pain?


Updated August 13, 2008

Question: Is Spinal Fusion the Best Treatment for Low Back Pain?
As spinal fusion has been around for quite a while, much is known by doctors about when to use it, and what to expect as far as outcomes go. Just the same, the research continues.

Spinal fusion is a standard treatment for people with chronic low back pain who don’t get relief from the best that conservative care or medical management can give them. This is the type of pain that is caused by degenerative changes in the spine, often due to aging.

Spinal Fusion or Physical Therapy?
If degenerative changes in the spine affect only 1 or 2 vertebrae (called "levels") and you don’t have spondylolisthesis or stenosis, the only treatment available for you to try before spinal fusion would be conservative care. This is why it’s best to give physical therapy your all, even when you don’t feel like it. That is also why it’s a good idea to leave no stone unturned, as they say, when seeking the best quality, most appropriate medical and holistic treatments available to you. (Treatments should be based on a proper diagnosis, of course.) The American Academy of Neurosurgeons recommends an intensive course of physical therapy and cognitive behavioral therapy before submitting to surgery, should medications and other pain management treatments not be giving you the relief you seek. If the pain stubbornly persists through the non-invasive treatments you try, perhaps it's time to consider spinal fusion.

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 very 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, or DDD, 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.

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. Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 7: intractable low-back pain without stenosis or spondylolisthesis. J. Neurosurg: Spine. 2005

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