Lumbar Discectomy vs. Fusion: Which Surgery is Right for Me?

By Frederick M. Moore, MD

If you’re suffering from leg or lower back pain caused by a lumbar herniated disc, you’re probably on the hunt for ways to address your discomfort and get back to living a comfortable, pain-free life. After you’ve exhausted your nonsurgical options, it may be the right time to consider spine surgery if the painful symptoms of a herniated disc are still present—but which surgical procedure is right for you?

We’ll break down lumbar discectomy and lumbar fusion to help you learn more about the different procedures and what they treat.

What is a lumbar discectomy?

Lumbar discectomy is a surgical procedure to relieve painful symptoms caused by a herniated disc in the spine, such as leg pain (sciatica), foot drop, muscle weakness, numbness or tingling in the legs, and decreased mobility. During a discectomy, a spine surgeon removes any free disc fragments that are putting pressure on your spinal nerves. This may be performed via a traditional midline incision, or with newer techniques that allow a smaller incision, which achieves decompression implementing fiberoptic technology.

There are different types of discectomy surgery, which can either be aggressive or limited with regard to removal of disc material depending on your spinal anatomy, the size of the hole(s) in your lumbar disc, and your overall health. During an aggressive discectomy, all free disc fragments—as well as any additional material located inside the disc—are removed. Limited discectomy takes a more conservative approach by removing free disc fragments without probing the inner core of the disc (nucleus pulposus) for additional material to remove.

What is a lumbar spinal fusion?

Lumbar spinal fusion is a surgical procedure that treats pain resulting from abnormal movement of the vertebrae, whether due to spinal deformities such as scoliosis, spinal weakness and instability, or a herniated disc.

During a lumbar fusion procedure, bones are permanently “fused” or essentially joined together to reduce motion in painful areas of the spine. In some cases, the entire disc is removed and replaced with bone-like material between the vertebrae, which ultimately takes the place of the natural disc that functioned as a stabilizer and shock absorber.

How do lumbar discectomy and spinal fusion differ?

While a lumbar spinal fusion can stabilize the spine and reduce pain from a herniated disc, lumbar discectomy is the most common surgical approach because it’s less invasive than a fusion, preserves movement, has a shorter recovery period, and is associated with fewer complications.

In fact, lumbar spinal fusion is rarely the first surgical intervention a patient will get for a lumbar disc herniation. It is typically performed further down the degenerative cascade, often after a patient has already had one or more discectomy procedures. Appropriately selected lumbar discectomy patients are more satisfied¹ with their results, and see fewer complications² than spinal fusion patients.

Despite the success of the discectomy procedure, there is a significant reherniation risk for approximately 30% of patients, often resulting in repeat surgery. Recently, newer technology (Barricaid) has significantly reduced the risk of reherniation for this group of lumbar discectomy patients.

Which surgical procedure is right for me?

The best way to determine whether you’re a candidate for lumbar herniated disc surgery—not to mention which procedure is the best fit—is to consult with a spine surgeon for a diagnosis and treatment recommendation. During your appointment, your physician may recommend a magnetic resonance imaging (MRI) scan to identify the root cause of the pain you are experiencing if you haven’t already been diagnosed with a lumbar herniated disc.

When determining the best option for you, your surgeon will consider the size and location of your herniation, the severity and duration of your symptoms, and the result of any previous treatments. If you are considering surgical intervention, the Barricaid implant can reduce your chances of needing a second discectomy surgery—and potentially a fusion—down the road if you have large holes (6 mm or larger) in your disc.

Take Diego, for example. Diego is a dedicated athlete with a lifelong passion for running and mountain climbing. After Diego suffered from multiple injuries that resulted in a lumbar herniated disc, several surgeons recommended a spinal fusion.

Diego explored his alternatives and chose a limited discectomy with Barricaid, an innovative technology that would allow him to return to the active lifestyle he loves with a lower risk of additional surgeries and disability.

If you’re suffering from a lumbar herniated disc and considering surgery, Barricaid may improve and enhance your outcome. Consult with our team at Southeast Orthopedic Specialists to see if you are a candidate for one of these ground-breaking procedures.