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The risks of lumbar fusion include:continuing low back pain if the patient was advised the surgery was primarily for low bak pain,infection (1%),paraplegia, catastrophic haemorrhage, leg paralysis, incorrect screw positioning penetrating a nerve root, spinal fluid leak,epidural fibrosis/arachnoiditis,major abdominal vascular injury, visual loss,adjacent level degeneration,non-union and escalation of low back pain.The indications for a lumbar fusion include: progressive and clinically significant instability and carefully assessed single level disease with lower back pain and no narcotic dependency or non-clinical adverse features. Surgery ,including fusions generally will not relieve lumbar back pain particularly when there is multi-level degenerative disease , no significant instability or non-clinical adverse features.Lumbar spine non-fusion surgery is likely to be highly successful for well chosen cases of sciatica,caudal equina syndrome or motor radiculopathy e.g. foot drop.

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Dr. Michael Coroneos

Neurosurgeon

Brisbane

Thank you for the question. Firstly, your question is quite common. Lumbar laminectomy is common and effective operation. If that runs its course, the next step is generally a lumbar fusion but it depends on the symptoms and the other non-surgical treatments that have failed. Unfortunately a lumbar disc replacement at the L4/5 level is an absolute contra-indication in patient's who have had a prior laminectomy. It is because the facet joints have been disrupted with the laminectomy and you need fully functional facet joints for a disc replacement to function optimally. Depending on the case, a disc replacement at the L3/4 level could however be an option. Age in itself is not an absolute contraindication and 60 is the new 50 in this era. Please see your favoured Spinal Specialist to seek a valid consultation.

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Dr Raoul Pope

Neurosurgeon, Orthopaedic Surgeon

Sydney

The relatively new procedure of lumbar disc replacement (arthroplasty) was developed to address this problem.

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Dr. Richard Parkinson

Neurosurgeon

Sydney

Fusion surgery is occasionally recommended for recurrent disc herniation, particularly with instability and back pain.

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Dr. Richard Parkinson

Neurosurgeon

Sydney

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