Latest / Neck & Back Surgery Answers with Dr. Leonard Kibuule / Spine Surgeon Reveals: When You DON’T Need a Spinal Fusion

Transcript

Spine Surgeon Reveals: When You DON’T Need a Spinal Fusion · Neck & Back Surgery Answers with Dr. Leonard Kibuule

• 0:00
  SPEAKER_00: If you've ever been told you need a spinal fusion, you're probably trying to answer one question.
• 0:04
  SPEAKER_00: Is this really necessary?
• 0:06
  SPEAKER_00: Because this isn't a decision you want to get wrong.
• 0:08
  SPEAKER_00: You don't want to have a major operation later find out a smaller procedure could have fixed the problem.
• 0:13
  SPEAKER_00: But you also don't want to keep suffering, keep losing function, and keep putting it off because you're afraid of the word fusion.
• 0:19
  SPEAKER_00: Part of what makes this so difficult is that if three spine surgeons looked at the same MRI, they might not all recommend the same operation.
• 0:27
  SPEAKER_00: I'm Dr.
• 0:28
  SPEAKER_00: Leonard Kabule, I'm an orthopedic spine surgeon here in Houston, Texas, and in this video I'll show you when I would not recommend a fusion.
• 0:36
  SPEAKER_00: When a small operation may be enough, and a few things that make me say, no, this spine really does need to be stabilized.
• 0:43
  SPEAKER_00: Let's start with the part that confuses a lot of people.
• 0:45
  SPEAKER_00: Sciatica does not automatically mean you need a fusion.
• 0:48
  SPEAKER_00: Numbness and tingling do not automatically mean you need a fusion.
• 0:52
  SPEAKER_00: Even weakness does not automatically mean you need a fusion.
• 0:55
  SPEAKER_00: Those symptoms tell me a nerve may be irritated or compressed.
• 0:59
  SPEAKER_00: They do not tell me by themselves that the spine needs to be stabilized.
• 1:03
  SPEAKER_00: Let's say you have pain shooting down one leg.
• 1:05
  SPEAKER_00: Maybe your foot is numb, maybe you have some weakness, and the MRI shows one herniated disc pressing on a nerve that matches those symptoms.
• 1:12
  SPEAKER_00: If that spinal level is otherwise stable, I may be able to remove a piece of the disc pressing on the nerve and leave the rest of the spine segment alone.
• 1:21
  SPEAKER_00: That is a microdysquectomy, not a fusion.
• 1:24
  SPEAKER_00: The same thing can happen with spinal stenosis.
• 1:26
  SPEAKER_00: You may feel pretty good sitting down, but after standing or walking for a while, your leg starts aching, getting heavy, feeling numb, or even weak.
• 1:34
  SPEAKER_00: If the problem is simply that the nerves do not have enough room and I can create more space without making the spine unstable, then a decompression alone may be enough.
• 1:43
  SPEAKER_00: And sometimes if your strength is intact and your symptoms are improving, the right answer may still be no surgery at all.
• 1:50
  SPEAKER_00: So if somebody tells you you have a herniated disc or you have stenosis or your MRI really looks bad, I'm not jumping from that diagnosis straight to a fusion.
• 2:00
  SPEAKER_00: The real question is whether I can solve the problem without destabilizing the spine.
• 2:05
  SPEAKER_00: Because if I can, I would rather do less.
• 2:07
  SPEAKER_00: If this is already helpful, subscribe to the channel.
• 2:11
  SPEAKER_00: I'm going to keep breaking down these spine surgery decisions, the differences between procedures, and the questions I hear from patients every day so you can understand your options before you make a major decision.
• 2:23
  SPEAKER_00: Now, there is a point where the answer changes and a fusion becomes the best option.
• 2:28
  SPEAKER_00: Take another patient with almost the same symptoms: leg pain, numbness, maybe weakness, maybe trouble standing or walking, but this time the nerve is being compressed because the disc space has collapsed, one vertebrae is shifting over another or the level is already unstable.
• 2:44
  SPEAKER_00: Now I'm looking at a different problem here.
• 2:47
  SPEAKER_00: I may still need to take the pressure off the nerve, but if I leave an unstable segment behind, I may not be able to solve the whole problem.
• 2:55
  SPEAKER_00: And sometimes the bone or the tissue I need to remove to free the nerve is also helping to support that portion of the spine.
• 3:01
  SPEAKER_00: If I remove enough of it, I can actually make the instability much worse and the scenario is much worse for the patient.
• 3:08
  SPEAKER_00: So now I'm asking two questions.
• 3:10
  SPEAKER_00: Can I free the nerve?
• 3:12
  SPEAKER_00: And after I do, will the spine still be stable?
• 3:15
  SPEAKER_00: If the answer to that second question is no, then a fusion starts becoming part of the conversation.
• 3:21
  SPEAKER_00: That is why two people can have very similar symptoms and need very different operations.
• 3:26
  SPEAKER_00: One may need a small decompression, the other may need a decompression plus a fusion because the level itself can no longer stay stable.
• 3:34
  SPEAKER_00: There are two things I see on MRI reports all the time that make patients assume a fusion is inevitable.
• 3:40
  SPEAKER_00: One is spondylolistesis.
• 3:42
  SPEAKER_00: That simply means one vertebrae slips or shifts relative to another.
• 3:46
  SPEAKER_00: The other is degenerative disc disease.
• 3:48
  SPEAKER_00: That means the disc and the surrounding tissues over time get worn.
• 3:52
  SPEAKER_00: Neither one automatically means you need a fusion.
• 3:55
  SPEAKER_00: With spondylolisthesis, I want to know whether the level is actually unstable, how much it moves, whether that movement matches the patient's symptoms, and whether freeing the nerve is going to make that spinal segment unstable and worse.
• 4:09
  SPEAKER_00: A small stable slip may not require fusion at all.
• 4:12
  SPEAKER_00: But if the level is clearly moving abnormally or starting to collapse, then I'm dealing with a totally different problem.
• 4:19
  SPEAKER_00: Degeneration is very similar.
• 4:20
  SPEAKER_00: Discs lose water or moisture, they can lose height, and arthritis develops as we get older.
• 4:27
  SPEAKER_00: This is very common, and I am not going to fuse a level just because an MRI says it's degenerative.
• 4:33
  SPEAKER_00: If you are functioning reasonably well, your symptoms are improving, your strength is good, or the imaging does not clearly match what you're feeling, then the MRI may itself not be enough.
• 4:44
  SPEAKER_00: A fusion has to solve a very specific problem.
• 4:47
  SPEAKER_00: And that brings us to the question I want every patient to ask before agreeing to a fusion.
• 4:53
  SPEAKER_00: What exactly is the fusion supposed to fix?
• 4:56
  SPEAKER_00: If someone recommends a fusion, you should be able to ask that question and get a very clear answer.
• 5:02
  SPEAKER_00: Not your back is bad, there's degeneration, the MRI looks terrible.
• 5:07
  SPEAKER_00: I want very specific answers.
• 5:10
  SPEAKER_00: Number one, this level is unstable.
• 5:13
  SPEAKER_00: The disc has collapsed enough that the nerve is losing space.
• 5:16
  SPEAKER_00: One vertebra is shifting over another, and that movement is part of the problem.
• 5:20
  SPEAKER_00: To adequately decompress the nerve, I would have to remove enough supporting structures that the level would no longer be stable.
• 5:27
  SPEAKER_00: Those are the answers I want to hear.
• 5:29
  SPEAKER_00: Now we are talking about an actual reason to fuse.
• 5:32
  SPEAKER_00: And if one surgeon recommends a fusion, another recommends a smaller operation, ask both the same thing.
• 5:38
  SPEAKER_00: What do you believe is causing the symptoms?
• 5:40
  SPEAKER_00: Then ask, can you solve that problem without fusion?
• 5:44
  SPEAKER_00: And if the answer is no, what would happen if you did the smaller operation?
• 5:48
  SPEAKER_00: These answers tell you much more than simply comparing the names of procedures.
• 5:53
  SPEAKER_00: Because sometimes the smaller operation is not enough.
• 5:56
  SPEAKER_00: Sometimes it is not at all enough.
• 5:59
  SPEAKER_00: What you want to do is understand why.
• 6:02
  SPEAKER_00: Because there is one more mistake people make once they decide they want to avoid a fusion.
• 6:07
  SPEAKER_00: They start assuming a smaller incision, and smaller surgery automatically means it's better.
• 6:12
  SPEAKER_00: I do fusions and I also perform minimally invasive spine surgery.
• 6:16
  SPEAKER_00: I teach these techniques, and a major part of my career has been trying to solve spine problems while trying not to disturb the normal anatomy as much as possible, trying to keep it intact.
• 6:27
  SPEAKER_00: So, yes, if I can solve the whole problem with a smaller operation, that is usually what I do.
• 6:33
  SPEAKER_00: But I do not want to shortchange somebody just because I can say I avoided a fusion.
• 6:39
  SPEAKER_00: Think about a tire.
• 6:40
  SPEAKER_00: If you have a small leak, maybe you patch it and you keep going.
• 6:43
  SPEAKER_00: But if the tire is blown out and collapsed and no longer supporting the car properly, a patch is not going to solve the problem.
• 6:50
  SPEAKER_00: At that point, you need to replace the entire tire.
• 6:54
  SPEAKER_00: The same principle holds for the spine.
• 6:56
  SPEAKER_00: If I can remove a piece of herniated disc or open up one crowded area and leave the segment still working and normal, great.
• 7:04
  SPEAKER_00: But if the disc has collapsed, the level is unstable, or the structure itself has failed, then a smaller procedure may leave the main problem untouched.
• 7:13
  SPEAKER_00: So the goal is not the smallest operation possible, it is the smallest operation that fully solves the problem.
• 7:19
  SPEAKER_00: So when don't you need a fusion?
• 7:22
  SPEAKER_00: Let me make this as clear as I can.
• 7:24
  SPEAKER_00: If your main problem is a compressed nerve, your spine is stable, and I can free that nerve without creating instability, I generally do not want to fuse that level.
• 7:34
  SPEAKER_00: A herniated disc does not automatically mean a fusion.
• 7:37
  SPEAKER_00: Sciatica does not automatically mean a fusion.
• 7:40
  SPEAKER_00: Numbness or tingling does not automatically mean a fusion.
• 7:43
  SPEAKER_00: Even weakness does not automatically mean a fusion.
• 7:46
  SPEAKER_00: Spinal stenosis does not automatically mean a fusion.
• 7:50
  SPEAKER_00: Spondylolysthesis does not automatically mean a fusion.
• 7:54
  SPEAKER_00: And a degeneration on an MRI definitely does not automatically mean a fusion.
• 7:59
  SPEAKER_00: What pushes me towards fusion is when I see something different underneath those symptoms.
• 8:04
  SPEAKER_00: Significant instability, a badly collapsed disc, abnormal movement between vertebrae or situation where adequately decompressing the nerve would leave the spine unstable afterwards.
• 8:16
  SPEAKER_00: That is the line I am trying to find before I recommend a fusion.
• 8:21
  SPEAKER_00: I do not want to do more surgery than you need, but I also do not want to do less surgery than it takes to actually solve the problem.
• 8:28
  SPEAKER_00: If you've been told you need a fusion and you're still not sure why, my team at Premier Orthopedics and Spine Health can review your symptoms, do an examination, and review the imaging with you to help you understand whether the proposed operation actually makes sense.
• 8:43
  SPEAKER_00: You can find the information to schedule an evaluation or a second opinion in the description below.
• 8:48
  SPEAKER_00: And if part of your problem is a herniated disc and sciatica, watch my video on when you actually need surgery for a herniated disc.
• 8:56
  SPEAKER_00: I'll show you when it still makes sense to wait, the signs that can make surgery more urgent, and how I decide when a patient has crossed that line.