Why do fusions not help back pain vs. radiculopathy?

[ans]

I had a discogram that at L5-S1 that was positive. It showed annular tears.

I haven't researched fusion and do not know why it doesn't help back pain much.

Any ideas appreciated.

Thank you very much.

ans

[annapurna]

I suspect that it depends on what hurts now and how much damage is left behind. Fusion is considered a last-second salvage surgery by most surgeons so it is reasonable to assume that significant damage to the facets has occurred as well as potential permanent nerve damage.

The nerve damage isn't going away no matter if you fuse or use ADR. Messed up facet joints can hurt, even if the fusion prevents movement across the joint. Serious disk height loss will lead to connective tissue damage; something that isn't going to be fixed by fusion. Speculatively, I'd wonder if the pain-goes-away success rate for fusion would be improved if surgeons tackled cases earlier. Of course, the lack of mobility of the fusion would probably irritate the heck out of the person who was fused while they still had most of their disk height and most of their mobility prior to the surgery.

[Jack]

The research I have done indicates the long term relief of both are about the same at a given disc level. The advantages of disc replacement would be faster recovery time and less potential damage to adjoining levels.


The variables are many. Skill of the surgeon is also key. The actual pain generators can also be many. Discogram interpretation is somewhat subjective. MRIs can show possible causes but not actual causes. Facets, nerve foramina, spinal stenosis, discs themselves, even adjacent levels can be involved.

I have even read that after a period of time, even after the pain stimulator is fixed, the person can still feel pain at that site. I never have quite understand the physiology behind this though.

[annapurna]

Neural plasticity, if I have the term correct, can account for pain at a location after the pain generator has been fixed. If a site generates pain very intensely for a long time, the pain nerves in the area proliferate and removal of the pain generator doesn't always eliminate the perception of pain.

[Jack]

Originally Posted by annapurna

Neural plasticity, if I have the term correct, can account for pain at a location after the pain generator has been fixed. If a site generates pain very intensely for a long time, the pain nerves in the area proliferate and removal of the pain generator doesn't always eliminate the perception of pain.

Yeah, that is what I was thinking of. It is kind of a scary concept for chronic pain people. All the more reason that getting whatever kind of repairs done sooner rather than latter is important.

[ans]

Thanks for your responses. Hmm, so the removal of the pain generator...reminds me of phantom pain. I'd like to research this stuff in a week.

[annapurna]

I suspect that it's slightly different between neural plasticity and phantom pain. My limited understanding of phantom pain is the remaining nerve tissue and nerves within the spine and brain make it seem like the removed part is still present and hurting. Neural plasticity doesn't require a part to be removed. If you imagine a ridiculously painful splinter left in a spot for yearss then removed; the pain nerves in that area have grown used to firing. The body decides that there's something seriously wrong in the area so it grows more pain nerves to let you know if the situation is getting worse. Eventually the splinter is removed and the wound heals but the extra pain nerves don't go away so the "base level" of pain perception in that area remains higher than the rest of your body and it effectively "hurts" even though nothing is wrong. Someone more aware of what is happening can probably tear my analogy to bits but that is my understanding of the effect.

[Slackwater]

Originally Posted by ans

I haven't researched fusion and do not know why it doesn't help back pain much.

Your topic / message is Fusion is performed for radiculopathy, not back pain ???
OK, not sure about that on this side, where is that written?


May I suggest (?) that there may be residual pain after a Fusion Surgery?
An orthopaedic surgeon at Rush University wrote the below:


Orthopaedic Excellence
A publication from Midwest Orthopaedics at Rush (MOR)
Volume 3, Issue 6
www.rushortho.com

Advances in Spine Surgery
Frank M. Phillips, MD

"Paraspinal muscle damage associated with open spinal surgeries contributes to postoperative pain and may be a source of chronic symptoms.

A significant amount of soft tissue dissection and muscle retraction
is required to perform spinal fusion and instrumentation. Several studies
have documented the harmful effects of extensive dissection and prolonged
retraction of soft tissues during lumbar spine fusion.

Studies have shown that after spinal surgery, damage to the lumbar muscles
is directly related to retraction duration. In addition, the incidence of low
back pain is significantly increased in patients with longer muscle retraction
times, and the degree of paraspinal muscle injury during surgery predisposes
to an increased risk for developing postoperative “failed back syndrome."
... etc."


Fusion surgery outcomes related to surgical duration may be in the literature.

Operative times are reported in the literature for Artificial Discs, I think,
because of the cause and effect of long surgeries.

Residual symptoms after surgery are felt by many, not just back surgery.
Hernia repair, dental surgery, hip resurfacing or arthroplasty ... may
have residual effects.



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slackwater_sf

[ans]

Thank you all for chiming in.

My facets are shot and I had retrostilothesis of ~ 4 mm some years go; for these reasons I thought that ADR is not for me.

My best..