What are the contraindications to surgery for lumbar disc disease?

Updated: Sep 25, 2018
  • Author: Kamran Sahrakar, MD, FACS; Chief Editor: Brian H Kopell, MD  more...
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Answer

Any claim of absolute contraindications for lumbar disc disease would invariably be challenged. Most spine surgeons adhere to some guidelines, including the following:

  • A patient with unrelenting back pain: Patients who have back pain after a bout of sciatica has resolved are not good candidates for operative treatment. Often, these patients are the most insistent and difficult to manage. Occasionally, these are patients whose back pain improved after discectomy for a large central disc herniation.

  • A patient with an incomplete workup: When diagnosis is uncertain, postpone surgery. Disc herniations are so ubiquitous that being cavalier in diagnosis is easy. Ensure the completeness of the workup prior to proceeding with the operation. All surgeons can recall several cases in which a diabetic plexopathy or an epidural metastasis was missed.

  • A patient not provided adequate conservative treatment: Spine surgeons rarely commit a patient with a short period of sciatica and without bedrest and a steroid trial to an operation that will permanently alter the patient's back mechanics and strength.


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