Is a L4-L5 fusion best if I only have leg nerve pain?

Ch2025
I am having DRX decompression for L4-5 issues. So this week will be 11 sessions. I decided to do the decompression because of numbness near my knee after a hip replacement.. still have numbness and knee problems with tightness and ligaments pulled and stretched up to my groin. Very painful when it happens. Don't know if it s related but
Just watching my movements.

ch2025back. Repairs to the disc often reherniate. There just isn't a great way to repair them. I'd probably avoid fusion. There are artificial discs that preserve motion.
It is hard to say because it depends on how much disc is left and how large the repair to the annulus fibrosis. You might consider a third opinion as well as an opinion from someone who practices disc replacement.

Thank you for replying. Both doctors said that I was not a candidate for a disc replacement (one of the doctors I went to does them) because of how severe the herniation is and the location of the herniation.
So the choice is fusion or another discectomy.

Thanks for your reply. I did decompression table after my L5 S1 discectomy. It was excellent and had great relief.
This time when I re-herniated the L4 L5 after the discectomy, I have not had the same results, but the herniation is pretty severe. Nerve pain is level 9–10 most of the day. I’ve also tried inversion tables and chiropractic. No relief because of the severity of the herniation against the nerves.

@ch2025back
Did they use an artificial disc when they did your discectomy or just remove your own disc material that was herniated? What did you do to herniate it again? Will you possibly do it again and need another surgery?

Do you have degenerative disc disease? What does your MRI of your lumbar spine show? Do you have stenosis/pinched nerve roots/nerves? Do you have any bone spurs?

I had decompression and fusion surgery in August 2024 on L3-L5. This was due to severe stenosis at L4-L5, degenerative disc disease, and neurogenic claudication. My symptoms pre-surgery were pain/numbness and weakness in lower back, hips, buttocks, legs and feet. Many of the symptoms improved. I do need to move a little differently when I bend down and reach for something or twist as my range of motion is now a little limited. I am 55 and expect multiple spine surgeries (had neck and back decompressed/fused and need another neck surgery next month). I have a congenitally narrow spinal canal so any degeneration affects me more than the average person.

@ch2025back Hello, and welcome.

Here's something that may help explain your condition as you describe the discs getting very thin. The surgeries you had were cutting off an extruded part of the disc that had squished out. At some point, the disc collapses further by herniating again, and by drying out with aging that also makes it thinner. The drying of the disc also tends to open cracks in the fibrous layer on the outer disk, further aiding weakness and another possible herniation. When discs get thinner, the vertebrae bones get closer together, and that leaves less room for the nerves that exit the spinal cord between them. It is possible to be able to move and put your spine into a bend or twist that could close down on a nerve if that foramen space is smaller, and the foramen could also have bone spur growth in it. That tends to happen from inflammation caused by a herniated disc if it goes into that space. The spine can also start to fuse itself if the vertebrae get close enough to touch, and they kind of remodel with aging that may make that more likely if they are also collapsing.

I know these are tough choices, and surgery takes a lot of effort in recovery.

My spine issue was compression of the spinal cord from the herniated C5/C6 disc with bone spur growth into the central canal. I did not have bone spurs in the foramen, and my disc had collapsed by 50%. Since the neck is so mobile, if I side bent my neck, it could touch the nerves and cause a burning pain. Then when I straightened back up, that pain went away. I had a fusion of C5/C6 done without hardware. I stayed in a neck brace for 3 months until it fused. That was several years ago, and I have been doing well ever since.

Thank you for the detailed information. This definitely helps me to better understand what’s going on. And it puts together some of the information I have heard from the doctors. This makes much more sense.

They just removed the herniated disc to relieve the nerve from being pinched.
But it reincarnated again within three months, so it was not a good fix
If they use it this time, they are going to remove the disk and put in a metal cage and then fuse the vertebrae together

Thank you for reply. Hopefully you can feel better soon.
Bless you