Q:

Hello doctor, 
i am a 54 yo male . I started having lower back problems in 2003. Since then i have received pain management, 3 steroidal injections, a facet block, a radio frequency block, multiple MRI, oa 2/28/05 i underwent a laminectomy, and after 8 weeks returned to work,for 2 1/2 months only to feel worse than ever. Returned to neurosurgeon who sent me for a diskography, from which the performing Dr. said it looked like i did not need a fusion..Waiting on CT scan results. Am i at the end of the line, i can’t go on like this. Its been a long painful time. Where do i go now?

A:

i’m sorry to hear about your continuing back problems. It would help to know what sort of symptoms you are experiencing, back pain or radiating pain to lower limbs?

In any case, it sounds like your doctors are evaluating you thoroughly, and not rushing to do a fusion, which is wise. Generally, intervertebral fusion should only be carried out if the symptoms and findings clearly indicate a problem with spinal instability. Because of the limited information available i cannot say anything about your situation in particular, but generally speaking, chronic back pain patients, especially when there is an accompanying chronic pain syndrome, rarely if ever benefit from spinal fusion. On the contrary, the situation may get much worse. There are some very carefully selected patients that may benefit.

If there is chronic pain, a consultation with a pain specialist should be done. Ideally, a team of physicians including an experienced spinal surgeon, pain specialist and physiatrist, should evaluate your case.