Diskectomy vs. Spinal Fusion

[caityc]

Hi Dr. Joshua! I have a question. I met with a neurosurgeon to discuss the results of my MRI. This is what the MRI said:

"At L5-S1, disc degeneration and prominent central and right paracentral disc herniation is identified impinging on the right sided nerve roots and also the right lateral recess.
Compression of the anterior thecal sac is also noted.
The AP dimension of the disc herniation is about 1.1 cm and the sagittal dimension is about 1.1 cm.
There is suggestion of mild inferior migration and I suspect this represents a disc extrusion.
Minimal bilateral neural foraminal narrowing is noted."
The neurosurgeon told me that I cannot have a diskectomy because it will cure the pain down my legs, but not the pain in my back. I need to have a spinal fusion or a disk replacement.
I know diskectomys are successful for many people. Based on the MRI, can you tell me why he said I have to have a fusion?

[Dr. Joshua]

As I do not have your history or the benefit of examining you physically, I can't give a definitive answer. I don't even know your symptoms. An MRI report is not sufficient to comment on treatment.

Most times a microdiscectomy is sufficient, and if instability related symptoms persist, a fusion can be considered later. However, if there is a clear indication of instability and also symptoms that point to instability (sudden, sharp back pain etc), physical findings, evidence of spondylolisthesis / spondylolysis on radiology, and possibly Modic changes in MRI, a fusion may be considered.

Your own neurosurgeon has the best information about your case. I cannot second guess him. If you are concerned, you can seek a second opinion. http://spinalfusion.info has some further discussion about these things.