One Spine Surgery only
Initially if you are going to perform surgery you need to do one surgery only.
Lumbar Spine Fusion has been performed for back and leg pain before 1986 and as a reserve for severe cases because with only a 50% success rate, it was held back for people that really did need a surgery.
Lumbar fusion had a 50-60% success rate; new instrumentation came in around 1987 or 1988 and stabilized the spine which bumped up the success rate to 80 or 90%.
Unfortunately indications for surgery are not that clear with many physicians being overly aggressive about back fusions. A failed back surgery, specifically a laminectomy for herniated disc, can be a recurrent disc which happens in 2-3% of the time. A patient who has a failure of laminectomy and had primarily back pain and leg pain will continue to have the same problem. Many times the disc is removed to relieve pressure on a nerve root, but if the primary problem was back pain, generally laminectomy will not work. A failure to diagnose the problem as a painfully generated disc as the pain generator is the problem. So a failed lumbar laminectomy would be related to a failure of diagnosis. A back fusion for that specific level would correct the problem. If one does a back fusion on a patient, and does one level and not clarified other levels of pain, then if the fusion is done at one level the others will be aggravated with time.
Generally speaking long term at 2-4 years, a patient can have about a 10% chance of an adjacent level degeneration. In other words if you fuse one or two levels you end up with excessive motion in another level.
Bottom line is one has to think very clearly what is going to be the outcome; what is the exit strategy. I am not a great fan of artificial disc in lumbar spine because what happens is in preserving the motion if the pain generator is preserved then it does not work.
Long story short though is one has to anticipate what goes on and what will have to be done in the future should this fail. A clear indication of the pain generator can be determined by:
Pressure on the nerve root,
Performing a discogram to diagnose a painful degenerative disc
Using a facet injection to duplicate and or resolve facet pain OR
A foraminal nerve root injections to clarify a lateral disc with pressure on a nerve root.
All these are diagnosis that can be made clearly to ensure the correct surgery is being performed.
When these things are done as when I do my back operations, I clarify where the pain generator is; find out what’s bothering and what’s not, and document it to the patients’ understanding before we proceed. The success rates can be as good or better then the primary surgery if it’s done correctly.
About The Spine Center of Miami
We believe in a conservative care approach to spine problems, which includes good diagnostic tests so a complete evaluation can be performed. After visiting the Spine Center of Miami and consulting with Dr. Nordt, patients have a good understanding of their condition. Thereafter a treatment plan for relieving their pain and discomfort can be developed, which may include surgery or other non invasive approaches. For more visit www.spinecentermiami.com