I've seen two surgeons (one orthopedic surgeon, one neurosurgeon) about my back pain. They both agree my problem is something called degenerative spondylolisthesis. What they don't agree on is how to treat it. The orthopedic surgeon thinks my age and general health are against me. The neurosurgeon is willing to operate as soon as it can be scheduled. I don't know which way to go.

Posted September 10th, 2009 by Matt

Spine Lumbar

Spinal fusion is still a safe and effective procedure for your condition. But based on recent studies, surgeons screen their patients more carefully before suggesting spinal fusion. And patients are more accurate information about what to expect, what could happen, and how likely it is that they might develop complications while in the hospital. This information will help both surgeons and patients weigh the pros and cons, risks and benefits of spinal fusion for this condition.

There's more work to be done in the area of patient selection for spinal fusion. For instance, investigation is needed to show how many people leave the hospital after spinal fusion surgery but are later readmitted for one or more complications. How and why do complications occur? Does the type of fusion that is done make a difference? How about number of levels fused or type of instrumentation used in the surgery (e.g., plates, screws, pins, wires)? There is plenty of room for additional study on this topic and in finding specific ways to reduce in-hospital complication rates.

Once this type of information is available, surgeons of all kinds can work to improve conditions and reduce complications. Until that happens, each patient is viewed on a case-by-case basis. Your individual characteristics are examined carefully. Neurosurgeons have training that might assist them in more difficult or complex cases. Many times, an orthopedic surgeon and a neurosurgeon work together in the operating room on patients who need the expertise of both.

It might be possible to have a telephone conference with both your orthopedic surgeon and your neurosurgeon to discuss the details of your situation. Communication is often the key to successfully establishing a plan of care that will give you the best results with the least trauma. If that doesn't seem possible, consider getting a third opinion with someone who can review what you have been told so far and make recommendations at this point in your process.

Paul S. Kalanithi, MD, et al. National Complication Rates and Disposition After Posterior Lumbar Fusion for Acquired Spondylolisthesis. In Spine. August 15, 2009. Vol. 34. No. 18. Pp. 1963-1969.

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