I had fusion surgery for a slipped vertebra. My back pain got better but I still have a nagging case of sciatica. Would it have helped if the surgeon took the disc out? Isn't that what's pressing on the nerve?

The gold standard for surgical treatment of spondylolisthesis (slipped vertebra) is an operation called posterolateral fusion (PLF). Bone graft material is either donated or taken from the patient's pelvic bone to form the fusion.

Decompression (disc removal) is done as part of a different procedure called posterior lumbar interbody fusion (PLIF). Once the disc is removed, then a wedge can be placed between the vertebrae. Bone chips are placed on either side of the wedge.

Some surgeons think the PLIF is better than the PLF for patients who have spondylolisthesis with sciatica. In theory, removing the disc should take pressure off the sciatic nerve and reduce or eliminate painful symptoms.

However, according to one study comparing PLF to PLIF, patients in the PLIF had more sciatica than patients in the PLF group. The researchers weren't sure how to explain this result. They suggested it may be related to other factors such as how severe the spondylolisthesis was or how much spine degeneration had occurred.

Reference: 

Per Ekman, MD, et al. Posterior Lumbar Interbody Fusion Versus Posterolateral Fusion in Adult Isthmic Spondylolisthesis. In Spine. September 15, 2007. Volume 32. Number 20. pp. 2178-2183.

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