Who should have this surgery?
The vast majority of people with low back pain will not need fusion surgery and will be able to manage the pain and stay functional with non-surgical care, such as physical therapy and conditioning. A spine fusion surgery may, however, be recommended for patients with the following:

• Back pain that limits the patient’s ability to function caused by degenerative disc disease (after nonsurgical treatments, such as physical therapy and medication, have failed)
• Isthmic, degenerative or postlaminectomy spondylolisthesis
• A weak or unstable spine (caused by infections or tumors), fractures, or deformity (such as scoliosis)

  • Modern lumbar spine fusion surgery • Lumbar spine fusion surgery for degenerative disc disease • Bone graft substitutes for lumbar spine fusion surgery • Spine fusion surgery animation

Because fusion is a major surgery, it is very important that all other possible causes of a patient’s back pain be considered and ruled out prior to undergoing fusion surgery. Generally fusion should not be considered until the lower pack pain has persisted for more than six months, and a concerted effort at conservative treatment has not relieved the pain. Fusion surgery is generally only considered for one or maybe two level problems. In general, multilevel fusions should be avoided.

Identifying the location of pain
If the patient is an appropriate candidate, and decides to have the surgery, the next important step is identifying the exact location of the excess movement that is causing the pain. The following methods are used for this:

1. Review of the patient history
   The physician will review when the pain occurs, where it appears to be located and how it began. He or she will also look at the previous treatment, and the extent to which the pain limits the patient’s activities. The physician will also decide if other factors (such as depression) may be contributing to the pain.
2. Physical exam
   A physical exam is done to determine if there is any evidence of a nerve-related injury. The physician will also consider how the patient’s overall health (e.g. heart or lung disease) may influence the role of the spine surgery.
3. Diagnostic studies
   An x-ray is usually done first to show if there is any instability or deformity to the spine. This is followed with magnetic resonance imaging (an MRI scan). MRI scans show very precise information about the health of the discs and any degree of degeneration that has occurred. It is important to note that degeneration is not uncommon, and may not be the source of the pain. Other tests, including a CT scan with myelogram, a discogram, electromyography, or a selective nerve root block may be ordered if the physician feels they’ll be beneficial. (Continued on next page.)