Stemcelldoc's Weblog

July 13, 2011

Lumbar Fusion: Adjacent Level Degeneration

Lumbar fusion is surgical procedure whereby the interverbral discs are fused in an effort to relieve pain.  The lumbar discs function as a shock absorber to absorb the forces of daily activity.

Do lumbar fusions impact the way in which our bodies manage the forces and stresses of daily activity?    Do they alter the body’s biomechanics?

Yes!

In a previous blog I have discussed the increased forces placed on the SI joint after lumbar fusion.  Clinically this often results in SI joint dysfunction and buttock and leg pain.

Are the discs above and below the fusion segment at risk for degeneration?

Ghiselli demonstrated the rate of symptomatic degeneration at an adjacent segment was 16.5% at five years and 36.1 at ten years.  The study involved 215 patients who had undergone lumbar fusion.  The average duration of followup was 6.7 years.

Bottom Line:  Lumbar fusion places you at risk for future surgeries.  Ghiselli demonstrated that at 10 years over 1/3 of  patients who underwent lumbar fusion had subsequent lumbar decompression or fusion at ten years.

BG is a case in point.  He is a 57 y/o patient who underwent L5/S1 fusion in 1992.  In 2005 the fusion was extended to L3/4 and L4/5 due to pain.  In 2008 a third fusion performed which involved the L2/3.   This month he presented to clinic with severe back and groin pain with an MRI significant for advanced degeneration at the L1/2 disc level with disc herniation.  He is tentatively scheduled for his fourth fusion.

The Centeno-Schultz Clinic offers non surgical alternatives for the treatment of lumbar degnerative disc and leg pain.

 

 

 

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