Why is fusion poor for back pain/good radiculopathy?

[johnb]

I'd say one size doesn't fit all. Spine problems are complex. My facet joints fused together, inside their capsules, after dynesys (they were a major undiagnosed pain generator) and I've been doing well since having the dynesys removed. They fused becuase their wasn't hardly any cartilage left on them, they were that bad but not diagnosed by a harvard trained, well respect surgeon in the southeast U.S. I still have the same detiorated discs but they aren't painful. In fact, L5-S1 looks is flat as a pancake but not painful AT ALL. I've met surgeons that don't share the fact that discs can lose their ability to generate pain at the latter stages of the deterioration process (of course, stenosis can develop with low disc height). In fact, I had one surgeon awhile back who told me that discs always become more painful the more they deteriorate. This was an obviously sales tactic to get me on the operating table. That kind of dishonesty is dispicable.

I kept hope alive but I honestly thought, especially after dynesys inplantation disabled me more instead of helping, that my situation was not going to improve as I've been dealing with back problems for over 15 years. I thought I was avoiding fusion but ended up with an unintended posterior fusion that has reduced my pain. Only time will tell if I have adjacent problems in the near term but I've been enjoying this reduction in pain. Get a good diagnosis and multiple opinions before decided on a course of action.

[ans]

Thanks for the responses and John, I hope that this fusion will work well till you're 100.

Hmm, my sense is that there really aren't any good methods to deal with annulus' pain e.g. IDET, nucleoplasty (is this relevant?), or any means. I hope I"m wrong. Also, I read that discs that are not positive for pain in a discogram can have painful annulus'.

I will check up on disograms that aim to alleviate pain as an indicator versus provoking pain. In the same vein, I wonder if - and this is dumb b/c a disc would have to be lifted up, if an annulus could be sprayed with lidocaine to r/o this as a pain generator.

Yap, a 2-3 level fusion's outcome from my research certainly has low success rates.

Be well folks. - ans

[mmglobal]

Surgeries that very effectively decompress the offended nervers are more effective at dealing with the radiculopathy associated with nerve compression. Wide laminectomies in which the posterior elements are removed are effective, but they also destablize the area. Typical decompression surgeries are trade-offs between how much they decompress vs. how much damage and destabilization they do.

With fusion surgeries, they have more license to do more decompression because when motion is halted extra structural support is added, they don't have to worry about destabilizing the system.

IMHO, the reason that they are are SOMETIMES not so hot for back pain are for 2 reasons. First is collateral damage from the surgery... big invasive surgery... especially big open posterior surgeries. The second is that most of us (especially those needing multi-level surgery) have multi-focal problems. The fusion will tend to overload the adjacent levels, accellerating degeneration and amplifying pain generators.

I don't think the annulus is in play here. Even in a posterior only fusion with the annulus left intact; once the system is immobilized the annulus will not be loaded substantially. In a 360 or anterior fusion, the posterior annulus will likely be removed or completely unloaded/immobilized.

John's point that 'one size doesn't fit all' is important. There are so many things that can go wrong and any of them can ruin our lives. Unfortunately, we often don't know which issues are important to us unless we are on the wrong side of a failed surgery.

Mark