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Is 'Transfominal Lumbar Interbody Fusion" or is 'Laminectomydisc' the right procedure to treat nerve compression on lower back?

Nov 2013
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Practicing since : 1994
Answered : 5293 Questions
My father is suffering from back problem caused by nerve compression where he is not able to walk more then 100 meters or stand for more then 10 minutes. He starts having numbness in legs starting from feet and moving up. Sitting or lying down comforts him. We have met several neuro-surgeons in Bangalore regarding his condition and they have all advised him surgery. I am attaching his MRI reports/Snaps here. Confusion is that some doctors have suggested "Transfominal Lumbar Interbody Fusion" surgery for him and some others Laminectomy. We are not sure which one is the right procedure for his case. Can you please advice us on the matter and if we should go ahead with this surgery in Bangalore? Also, it will really help if you can advice us if there is a way we can avoid this surgery through some other means?
Posted Sat, 11 Jan 2014 in Brain and Spine
Answered by Dr. Sudhir Kumar 39 hours later
Brief Answer: My answer is below. Detailed Answer: Hi, Thank you for posting your query. I have noted the symptoms of your father and also seen the MRI spine films. His symptoms are due to disc bulges and nerve compression in the lower back, most severe at L3-4 level. Medications such as pregabalin or gabapentin capsules, physiotherapy, bed rest and precautions (such as avoiding forward bending and weight lifting) would help about 30-40% patients and surgery may be avoided. If he has not done these, it may be done for 4-6 weeks. However, if the above have been tried and his symptoms have not improved, then, surgery should be done. The aim of the surgery is to relieve the compression of the nerves (can be achieved with laminectomy and discectomy). In addition, if there is instability or weakness of bones of spine, then, inter body fusion should also be done. This can be decided by clinical examination of the patient and additional tests such as isotope bone scan and bone densitometry. I think, you can get the surgery done at Bangalore in any of the good hospitals there. I hope my answer helps. Please get back if you require any additional information. Wishing you good health, Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist Apollo Hospitals, Hyderabad, India Click on this link to ask me a DIRECT QUERY: My BLOG:
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Follow-up: Is 'Transfominal Lumbar Interbody Fusion" or is 'Laminectomydisc' the right procedure to treat nerve compression on lower back? 37 hours later
Thanks Doctor. Neurosurgeon here has decided to do fusion by looking at xrays i attached to this question. He did not do any clinical examination nor am I in a severe pain in legs or back. Do you think that fusion (TLIF) is relevant choice in this case?
Answered by Dr. Sudhir Kumar 40 minutes later
Brief Answer: Thank you for getting back. Detailed Answer: It is unfortunate that the neurosurgeon decided to operate without doing clinical examination, and without correlating the MRI findings with patients symptoms. I would advise against surgery, if your father does not have leg pain, or claudication pain (pain in legs on walking, which is relieved with rest). So, it may be better to consult another neurologist or neurosurgeon before a final decision is made. Best wishes, Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
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