I'm looking into having lumbar fusion at the L45 level for degenerative disc disease. Are there any good ways to tell if I'm really going to be helped by this procedure? I know people who have back surgery and they never seem to get better.

With the large number of people every year who come to the surgeon with chronic low back pain, the corresponding number of back surgeries has also increased dramatically. Spinal fusion is a common stabilizing procedure used for stenosis, degenerative disc diesease, and spondylolisthesis (tiny fracture or defect in the supporting column of spinal bone).

Your question is a reasonable one but it's very confusing trying to figure out ahead of time which patients will benefit from back surgery. Surgeons are always looking for predictive factors to help them identify who should have surgery and who would be better off without surgery.

One of those predictors is the use of pain drawings. Patients draw lines, X's, dots, and use letters like N for numbness or S for muscle cramps on a picture of the human body. The various markings show where pain is located and what kind of pain it is.

Some aspects of this drawing are helpful when evaluating risk of good versus poor outcomes after spinal fusion. For example, patients with unorganized pain patterns express greater dissatisfaction with results of fusion surgery. On the other hand, patients with a more recognizable pain pattern are more likely to report better results after surgery -- even when they had more levels fused than in the nonorganic group.

Work status (retired or on sick leave) and insurance or litigation claims are two other predictive factors of poor outcome. Patients who have pain lasting more than two years, patients who smoke, and younger patients are also at risk for poor results after fusion surgery.

There isn't a one-tool-fits-all kind of assessment that can be used before surgery to predict outcomes after surgery. By sitting down with your surgeon and reviewing your individual risk factors, you may be able to see where you fall in the line up from success to failure following lumbar spine fusion.

Reference: 

Thomas Andersen, MD, PhD, et al. The Predictive Value of Pain Drawings in Lumbar Spinal Fusion Surgery. In The Spine Journal. May 2010. Vol. 10. No. 5. Pp. 372-379.

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