Randy Shelerud, M.D., Mayo Clinic specialist in physical medicine and rehabilitation

The best candidates for spinal fusion surgery or other aggressive treatments are those who have focal pain symptoms and have a very well defined pathology or disease process to account for their back pain. For instance, the most common reason for fusion surgery is an unstable spine, and we can pick that instability up by looking at X-rays. But in those patients without instability, they at least need a study called a discogram that would help to suggest the presence of a single disk as the source of their pain.

Now having said that, patients certainly need to have exhausted all reasonable nonsurgical treatments over a reasonable time frame, such as at least a six-month period of time, and have given an honest effort to those treatments before proceeding to any consideration about surgery. Now having said that then, patients who have rather regional or diffused pain, and particularly those who have a lot of psychological overlay to their pain problems, don't tend to do well with fusion surgeries and they're therefore not looked at as good candidates.

The final points are that patients need to be realistic about their goals for this procedure. The example that I like to give is that typical fusion patients will reduce their pain from 7 out of 10 on a zero to ten scale before surgery to something like 3 to 4 out of 10 after surgery. So, patients who come into this procedure thinking that they will be cured will obviously not have a favorable outcome.

And finally, we look at patients who are motivated. Not only motivated to maintain their health in other ways through trying to maintain their fitness as high as they can and eating right and getting proper sleep but also motivated to follow through with the postoperative rehabilitation that's required as well as looking at cessation of smoking if that's been recommended and eliminating the use of prescription narcotic drugs.

VIDEO HELP

If the video does not play, you may need to download and install the latest version of the Adobe Flash Player. For additional troubleshooting tips, browse the Multimedia FAQ.