Should I Have a Second Spine Surgery?

Woman sitting up in bed holding her low back and having painQuestion: I had a successful lumbar fusion (L5-S1) about 12 years ago. I now have instability at the adjacent joint (L4). Does a second fusion cause additional risks or complications since I have spinal hardware in place?
—Sioux Falls, SD

Answer: Because you already have spinal instrumentation in place, a second fusion can cause additional risks and complications. With that said, that doesn't mean a second fusion is completely out of the question.

But deciding whether you need another spine surgery can be tricky. To help you make your decision, you'll need to discuss your surgery options with your surgeon—find out whether he or she recommends a second fusion. That is usually determined by the severity of your instability and your level of pain.

Instability of the joints above or below the joints that were fused is somewhat common after fusion. When you have a fusion done to make one part of your spine stronger, it can actually make another part of your spine weaker, something spine surgeons work hard to avoid when planning surgeries.

To determine the severity of your instability at L4, the surgeon will use imaging tests: x-rays, CT scans, or MRIs. These tests will help him or her see the extent of the instability.

In your situation, in order to stabilize your L4 and prevent further complications or pain, you may need another surgery—possibly another fusion.

Keep in mind that your risks increase with another surgery. Your surgeon will have to take into account your previous instrumentation and fusion when planning the surgery. However, with careful planning, your surgeon can figure out how to work around your previous surgery in a way that addresses your current pain.

Ultimately, your surgeon's guidance can help you with your decision, but whether you have a second fusion is up to you.