Lumbar Discectomy and Fusion

Some doctors routinely give a spinal fusion to their discectomy patients. But is it always necessary?

Generally, you will not automatically be given a spinal fusion when you have surgery for herniated disc. The reason is that so far, at least, research doesn't support the benefit to you as a patient of a discectomy with fusion. Because of conflicting study results, experts figure that the added cost and potential for related health problems just isn’t worth it, so they refrain from recommending it to the surgeons who follow their guidelines.

Doctor showing x-ray image to patient
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As with anything in life, there are exceptions, of course. If you are found to have spinal instability along with your herniated disc, research shows that the fusion may be valuable. But the fact is, most people going into surgery for a herniated disc don’t have spinal instability. Only about 5% of patients do, according to Resnick, et. al in their 2005 Guidelines published in the Journal of Neurosurgery: Spine.

More common scenarios for adding in a spinal fusion to a discectomy include being an athlete and/or heavy manual laborer with chronic low back pain and radiculopathy (leg pain and nerve symptoms.)

If this will not be your first disc surgery, the fusion may be helpful here as well. Research comparing reoperations (having the first surgery redone) with and without fusion found that both were helpful in relieving pain and improving function. But the only time a fusion is definitively recommended with discectomy is when a second surgery is being done in the same area because your disc problems have returned, along with an associated deformity, instability and/or the presence of chronic low back pain.

Artificial Disc Replacement

In the U.S. artificial disc replacement is a relatively new (as of 2016) procedure that seeks to relieve pain and restore motion between affected vertebrae by replacing a damaged intervertebral disc with a prosthesis. It is thought that spinal fusion, which results in immobility at the area the procedure is done, is associated with subsequent degenerative changes that occur in the spinal segments above and below. A disc replacement can theoretically avoid this degeneration.

Although research continues to accumulate, not all the questions about disc replacement have been answered. For example, scientists still do not know if it really does help you avoid adjacent segment degeneration or disease (ASD). In fact, some experts don't believe that ASD is caused by spinal fusion at all. Just the same, spinal fusion is considered a "gold standard" procedure; it is still the procedure of choice in many types of spine surgery, and certainly when a disc replacement is an alternative.


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  • Resnick, D., Choudhri, T., Daily, A., Groff, M. Khoo, L., Matz, P., Mummaneni, P., Watters, W., Wang, J., Walters, B., Hadley, M. Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 8: lumbar fusion for disc herniation and radiculopathy. J Neurosurg: Spine 2:673–678, 2005.
  • Wang J., Dailey A., Mummaneni P., Ghogawala Z., Resnick D., Watters W., Groff M., Choudhri T., Eck J., Sharan A., Dhall S., Kaiser M. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 8: lumbar fusion for disc herniation and radiculopathy. J Neurosurg Spine. July 2014..