Some types of back surgery are far more predictable in terms of alleviating a patient’s symptoms than others. For instance,
A discectomy (or microdiscectomy) for a lumbar disc herniation that is causing leg pain is a very predictable operation. However, a discectomy for a lumbar disc herniation that is causing lower back pain is far less likely to be successful.
A spine fusion for spinal instability (e.g. spondylolisthesis) is a relatively predictable operation. However, a spine fusion for multi-level lumbar degenerative disc disease is far less likely to be successful in reducing a patient’s pain.
Therefore, the best way to avoid a spine surgery that leads to an unsuccessful result is to stick to operations that have a high degree of success and to make sure that an anatomic lesion that is amenable to surgical correction is identified preoperatively.
The above applies to me as I did have multi-level DDD and have now been diagnosed with further degeneration at the L3/L4.
Transfer lesion to another level after a spine fusion
A patient may experience recurrent pain many years after a spine fusion surgery. This can happen because the level above a segment that has been successfully fused can breakdown and become a pain generator.
This degeneration is most likely to happen after a two-level fusion (e.g. a fusion for L4-L5 and L5-S1 levels) and in a young patient (in the 30-50 year old age range).
It is much less likely to happen if only the L5-S1 level is fused, as this segment typically does not have much motion and fusing this level does not change the mechanics in the spine all that much.
Most of the motion in the spine is at the L4-L5 level, and to a lesser extent at L3-L4. When the L4-L5 level is included in the spine fusion it transfers a lot of stress to L3-L4. This does not present as much of a problem for elderly patients, since they tend to not be as active nor do they have the fusion for as many years.
My fusion was done at the L5/S1 and as I said before the last MRI did indeed show further degeneration at the L3/L4. This makes me seriously wonder if the arachnoiditis is causing all the pain I am having. While I am sure that it is part of the problem this makes me think that the DDD and arachnoiditis are acting in concert. It's a conspiracy damnit!!! I am also at the front end of the age range they mention, being that I am 34.
The article also discusses metal hardware failure before the fusion is completed but I know that at my 3 month post op x-rays my neurosurgeon was very impressed with the rate of fusion. He mentioned that it was much quicker then he expected considering they used donor bone and not my own. So I have some dead guys bone grafts and I don't even know his name. I can tell where the hardware is located though. My lower back in the area it is installed is always a bit swollen and it also limits my range of motion. I have had it prevent me from moving in a certain way. When that happens it feels like you stepped off the curb or the last stair the wrong way. You know that pain that shoots up your back when that happens? That is what it feels like, only it does not go away as quickly.
I am confident that the surgery I had was successful in respect to stabilizing the L5/S1 but looking back I would say that I was not well informed as to post op issues. My neuro and I did discuss that the surgery might not work at all, it might cause more pain then before or it would be a success but I do not recall us discussing that using hardware in one location might lead to new or further degeneration at other levels. I guess hindsight is indeed 20/20 because as I think about it, it makes sense. Should the need arise for another surgery I would like to think that I am now more informed then I was last time.
I do like that they end the article with the fact that the surgery itself is not enough to relieve the symptoms and that it should be followed up with a good physical therapy program. I was lucky and had some great folks working on my physical therapy with me.
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