Spinal Fusion Surgery: When to Consider It for Young Patients

Q: Spinal Fusion Surgery: When to Consider It for Young Patients

Hello： Based on what you mentioned, 1. <br>I am 21 years old this year, but my condition is not severe; I do not experience numbness in my hands or feet, just some back pain when standing or sitting for long periods. <br>I would like to ask the doctor if, given my situation, it w

Spinal fusion surgery

Hello Doctor: I have been experiencing frequent lower back pain whenever I stand or sit for long periods.
Recently, I was diagnosed with a dissociation between the fifth lumbar vertebra and the first sacral vertebra, as well as spondylolisthesis (grade 1 to 2).
The doctor mentioned that my condition is congenital, and since I am still young, he does not recommend immediate surgery.
However, I found online that some people who underwent surgery for similar issues experienced numbness and pain in their limbs post-operatively, even if they did not have these symptoms before.
I would like to ask the doctor: 1.
I am 21 years old, and my condition is not severe; I do not experience numbness in my limbs, but I do have some lower back pain when standing or sitting for extended periods.
Given my situation, would it be better to consider minimally invasive surgery with screws for stabilization early on (early detection and early treatment), or is it acceptable to wait until I experience nerve compression or significant discomfort before proceeding? 2.
Have you encountered similar cases in your clinical practice, where patients had congenital issues and were relatively young?

Ellen, 20~29 year old female. Ask Date: 2017/07/07

Dr. Lai Zhaokang reply Neurosurgery

Hello: Based on what you mentioned, 1.
I am 21 years old this year, but my condition is not severe; I do not experience numbness in my hands or feet, just some back pain when standing or sitting for long periods.
I would like to ask the doctor if, given my situation, it would be better to consider minimally invasive surgery with steel screws for stabilization early on (early detection and early treatment), or if it is acceptable to wait until I experience nerve compression or significant discomfort before proceeding.
2.
Has the doctor encountered similar cases in clinical practice, particularly with younger patients who have congenital issues? Response: 1.
You are only 21 years old.
If you feel that your back pain is not severe and you do not have neurological symptoms leading to pain or numbness in your lower limbs, I personally suggest waiting until you are truly uncomfortable before discussing surgery (unless the MRI findings are indeed severe).
// However, you should wear a back brace, avoid bending over, refrain from lifting heavy objects, and engage in more stretching exercises.
2.
I personally encounter cases at your age or even younger.
If you have not experienced any significant injuries, it is generally congenital.
Best wishes, Dr.
Lai Chao-Kang, Chief of Spine and Nerve Surgery at Changhua Hospital.

Reply Date: 2017/07/07

More Info

When considering spinal fusion surgery, especially for young patients like yourself, there are several important factors to take into account. Your situation, involving a diagnosis of spondylolisthesis and a congenital predisposition, raises questions about the timing and necessity of surgical intervention.

1. Understanding Your Condition: At 21 years old, experiencing mild discomfort without neurological symptoms (like numbness or weakness in the legs) suggests that your condition may not warrant immediate surgical intervention. Spondylolisthesis, particularly at a low grade (1-2), often can be managed conservatively. This includes physical therapy, pain management, and lifestyle modifications such as avoiding prolonged sitting or standing, which can exacerbate your symptoms.
Surgical options, including minimally invasive techniques, are typically considered when conservative treatments fail to alleviate symptoms or if there is significant nerve compression. Given that you do not currently experience severe pain or neurological deficits, it may be prudent to monitor your condition closely rather than rushing into surgery.
2. Timing of Surgery: The decision to proceed with surgery should be based on the progression of your symptoms and any changes in your condition over time. If you begin to experience increased pain, neurological symptoms, or if imaging studies indicate worsening of your condition, then surgical options may need to be reconsidered. Early intervention is beneficial in some cases, but unnecessary surgery can lead to complications and prolonged recovery.

3. Clinical Experience with Similar Cases: It is not uncommon for healthcare providers to encounter young patients with congenital spinal issues. Many of these individuals manage their symptoms effectively through conservative measures. In your case, since your symptoms are mild and manageable, it is likely that your physician's recommendation to avoid immediate surgery is appropriate.
4. Potential Risks of Surgery: While spinal fusion can provide relief and stability, it is not without risks. Post-operative complications can include infection, nerve damage, and the potential for adjacent segment disease, where the levels above or below the fusion may degenerate more rapidly. Additionally, some patients report persistent pain or new symptoms following surgery, which can be distressing.

5. Lifestyle Modifications and Rehabilitation: Engaging in physical therapy focused on strengthening the core and back muscles can be beneficial. This may help alleviate some of your discomfort and improve your overall spinal health. Additionally, maintaining a healthy weight and avoiding activities that place excessive strain on your spine can help manage your symptoms.

In conclusion, given your age and the current severity of your symptoms, it may be best to adopt a conservative approach for now. Regular follow-ups with your healthcare provider to monitor your condition are essential. Should your symptoms worsen or change, you can then revisit the discussion about surgical options, including spinal fusion. Always ensure that you have open communication with your healthcare team about your concerns and treatment preferences.

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