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Suggest treatment for pain in back other than spinal fusion

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Posted on Thu, 19 May 2016
Question: Had a MRI taken over a year ago and the impression came back as severe canal stenosis at L4-L5 with diameter reduction to 7mm with severe right-sided neural foraminal narrowing due to broad based disk bulge and superimposed facet hypertrophic changes. Findings are also exaggerated due to the 2mm to 3mm of anterolateral a of L4 on L5. Disk desiccation noted at lower two levels, along with mild levoscoliosis.
Now since then, I've been rehabbing my own back through conservative methods and my back is about 50% better. Pain levels 2-3/10 with XXXXXXX at 7/10 where prior pain levels stayed at 6-7 with peak at 8/10. A neurosurgeon at the beginning of treatment informed me only solution for my issues was fusion.
My question would be, is there other options out there to help decrease pain i.e. Lamenectomy, discectomy? I don't want to debilitate myself completely and miss my window for a less invasive surgery that would ride my back pain.
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Answered by Dr. Olsi Taka (52 minutes later)
Brief Answer:
Read below.

Detailed Answer:
I read your question carefully and I understand your concern.

I must say I share your reluctance to undergo spinal fusion. You seem to have gotten better through conservative means (physical therapy) which is good. Studies regarding long term efficacy of surgery have variable results, there are indications that while it may provide a quicker improvement in the long run physical therapy may achieve more or less similar results. Of course if there is an acute compreassion risking to lead to permanent muscle weakness or loss of bladder control surgery is necessary, but this isn't such a case.

Also fusion may solve the issue for the moment, but because mobility at that level is lost, other intervertebral levels have to endure more stress than usual to compensate. Hence over the years issues may arise at those levels, a real possibility since you are young and have many years ahead of you.

So I would stick with physical therapy for some more time. For chronic neuropathic pain medication like Gabapentin, Pregabalin or Amitriptyline may be considered.

If no further improvement present and surgery is really necessary simple laminectomy would be a preferrable solution. There are cases though where there is instability of the spine and that is not enough. If your surgeon thinks that is your case due to the broad based bulge (could ask for a second opinion as well), then apart from fusion now there is in recent years the possibility of using artificial discs. These discs have the advantage of conserving mobility between the two vertebrae.

I remain at your disposal for other questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Olsi Taka

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Practicing since :2004

Answered : 3669 Questions

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Suggest treatment for pain in back other than spinal fusion

Brief Answer: Read below. Detailed Answer: I read your question carefully and I understand your concern. I must say I share your reluctance to undergo spinal fusion. You seem to have gotten better through conservative means (physical therapy) which is good. Studies regarding long term efficacy of surgery have variable results, there are indications that while it may provide a quicker improvement in the long run physical therapy may achieve more or less similar results. Of course if there is an acute compreassion risking to lead to permanent muscle weakness or loss of bladder control surgery is necessary, but this isn't such a case. Also fusion may solve the issue for the moment, but because mobility at that level is lost, other intervertebral levels have to endure more stress than usual to compensate. Hence over the years issues may arise at those levels, a real possibility since you are young and have many years ahead of you. So I would stick with physical therapy for some more time. For chronic neuropathic pain medication like Gabapentin, Pregabalin or Amitriptyline may be considered. If no further improvement present and surgery is really necessary simple laminectomy would be a preferrable solution. There are cases though where there is instability of the spine and that is not enough. If your surgeon thinks that is your case due to the broad based bulge (could ask for a second opinion as well), then apart from fusion now there is in recent years the possibility of using artificial discs. These discs have the advantage of conserving mobility between the two vertebrae. I remain at your disposal for other questions.