Question
February of 2003 I was 26yrs old (female).  I had a herniated disc and part of it broke off and was lodged into my nerve.  At that time I also found out that I have degenerative disc disease in the last three discs.  I had back surgery in the L-4, L-5 area (which is the same place my mother and grandmother had back surgery).  My mother had fusion surgery and it went very well and she's had no complications.  When we acquired about fusion to my surgeon he stated that I was too young for the fusion.  Here it is the next year and I'm starting to have problems again.  My back pain is getting worse and Aleve is no longer helping.  I'm not sure if this played a part in his decision but I am overweight. I was just wondering if I should of had the fusion done, and was I really too young to have it?   

Thanks!
Katrina Stevens  

Answer
Hello Katrina,

The decision whether to fuse or not, is a complex decision which requires the surgeon to take into consideration several factors.
When a motion segment (= two vertebrae and the disc between them) is fused, we intend that this segment will cause no further pain, but on the other hand a longer lever arm will be applied to the disc above and below and this theoretically might increase their rate of degeneration. Another consideration is the reduction in the range of motion a long fusion will cause.
You have stated that you have disc disease in at least two other disc spaces. This, on top of your relatively young age, would be a good reason not to fuse.  An alternative available outside the US is Disc replacement surgery. In this type of operation, the disc is removed completely and replaced with an artificial prosthesis that allows motion to continue between the two vertebrae. This is a good option in young patients with diffuse degenerative disc disease and back pain, in which we have verified that the disc is indeed the pain generator. On the other hand, if all you have is radicular (leg) pain, and no back pain, a decompressive procedure such as you have had, is all that is required.

Sincerely,

Dr. N. Rahamimov