Procedure of the Month

You Chose Selection #3:
Decompression and interbody fusion L4-5 and L5-S1

Aha, we thought you might pick this one! Close, but no cigar. Why isn’t decompression and interbody fusion the best treatment option? First, the majority of our patient’s pain is radicular pain (90%) not mechanical back pain (10%). Since the majority of her symptoms appear to be originating from the S1 nerve root, a decompression is indicated, but there are no clear indications for interbody fusion. Therefore, if fusion surgery is considered, a discogram may be useful in order to evaluate whether the disc at L4-5 is the pain generator. Third, given her young age (26 years), fusion surgery should be delayed for as long as possible since it may put her at risk for accelerated degeneration of her adjacent disc. Lastly, if she continues to have worsening back pain after decompression alone, she would still be a potential candidate for interbody fusion if indicated.

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