Spinal Fusion Surgery for Spondylolisthesis: Key Questions Answered

Spinal fusion surgery for spondylolisthesis?

Hello Dr.
Chang, I was recently diagnosed with spondylolisthesis at the fourth and fifth lumbar vertebrae and need to undergo fusion surgery.
Currently, I am experiencing significant pain in my left sciatic region, and after sitting for a long time, I also feel pain in my coccyx.
When I stand up, the muscles around my coccyx cramp (like a spasm), and the pain radiates down the back of both thighs, making it difficult to walk.
Therefore, I have a few questions:
1) Should I seek surgery from an orthopedic surgeon or a neurosurgeon? What are the differences between the two specialties in terms of surgical approach?
2) I have seen doctors who reviewed the same MRI report, and some suggest using four screws while others recommend six.
Why is there this discrepancy? Does using four screws result in less damage to the spine?
3) Is minimally invasive surgery covered by health insurance?
4) What materials are preferable for bone screws or implants during surgery? What factors should be considered when making this choice?
5) Will the surgery cause damage to the vertebrae above the fused segments in the future?
6) I have heard that back pain may still persist after surgery; what is the reason for this? Thank you for your answers.

Denise, 50~59 year old female. Ask Date: 2016/05/20

Dr. Zhang Junwei reply Neurosurgery

You can consult either an orthopedic surgeon or a neurosurgeon.
It is recommended to bring your MRI to the outpatient clinic to discuss it with the physician!

Reply Date: 2016/05/20

More Info

Hello! Thank you for your detailed questions regarding spinal fusion surgery for spondylolisthesis. I understand that you are experiencing significant pain and discomfort, and I will do my best to address your concerns comprehensively.

1. Choosing Between Orthopedic and Neurosurgery: Both orthopedic surgeons and neurosurgeons are qualified to perform spinal fusion surgery. Orthopedic surgeons typically focus on the musculoskeletal system, including bones and joints, while neurosurgeons specialize in the nervous system, including the brain and spinal cord. The choice between the two often depends on the specific nature of your condition and the surgeon's expertise. If your primary issue is related to the structural integrity of the spine, an orthopedic surgeon may be more appropriate. Conversely, if there are significant neurological concerns, such as nerve compression, a neurosurgeon might be the better choice. It's essential to consult with both types of specialists to determine the best approach for your specific case.

2. Variability in Surgical Plans: The difference in recommendations regarding the number of screws (4 vs. 6) can be attributed to several factors, including the surgeon's preference, the specific anatomy of your spine, and the extent of the spondylolisthesis. More screws can provide greater stability, but they may also increase the risk of complications. A surgeon who opts for fewer screws may believe that the remaining screws will provide sufficient support. It's crucial to discuss these options with your surgeon to understand the rationale behind their recommendation.

3. Insurance Coverage for Minimally Invasive Surgery: In many cases, minimally invasive spinal surgery is covered by health insurance, but this can vary by provider and specific policy. It's essential to check with your insurance company to confirm coverage details. Minimally invasive techniques often result in less tissue damage, reduced pain, and quicker recovery times, making them an attractive option for many patients.

4. Material Selection for Screws and Implants: The choice of materials for screws and implants typically includes titanium and stainless steel, both of which are biocompatible and durable. Titanium is often preferred due to its strength and lower risk of corrosion. When selecting materials, factors to consider include the surgeon's experience with specific products, the potential for allergic reactions, and the long-term outcomes associated with different materials. Discussing these options with your surgeon can help you make an informed decision.

5. Impact on Adjacent Vertebrae: It is a common concern that spinal fusion may lead to increased stress on adjacent vertebrae, potentially causing degeneration over time. This phenomenon is known as adjacent segment disease. However, many patients successfully manage their symptoms and maintain a good quality of life post-surgery. Your surgeon can provide insights into how to minimize this risk through proper surgical technique and rehabilitation.

6. Post-Surgical Pain: Experiencing pain after surgery is not uncommon. This can be due to several factors, including the healing process, muscle tension, or nerve irritation. It's essential to communicate any persistent pain to your healthcare team, as they can recommend appropriate pain management strategies and physical therapy to aid in your recovery.

In conclusion, spinal fusion surgery can be a highly effective treatment for spondylolisthesis, but it is essential to have open discussions with your surgical team about your concerns and expectations. Each patient's situation is unique, and personalized care is crucial for achieving the best outcomes. I wish you the best of luck with your surgery and recovery!

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