Last year I had a disc removed and a spinal fusion done. Last month I slipped and fell at the grocery store. There is a fracture in the spine that just isn’t healing. The surgeon wants to do a fusion. The last fusion I had hurt so much, I vowed I would never do it again. But now this fracture hurts so much I’m considering it again. What should I expect?

There are several factors to consider in a case like this. First of all, there are differences in reported pain after fusion when the patient donates his or her own bone for the graft.

Twice as many patients who have surgery for a painful low back disorder have donor site pain. This is compared to patients who have fractured their spine. Doctors aren’t sure how to account for the difference.

It may have to do with the patient’s ability to cope after an accident or injury versus after a degenerative condition. The intensity of the pain seems to be worse for patients who have a fusion at L3 or below.

The most likely explanation for this to occur is that the bone donated is taken from the posterior iliac crest. This site is not that far from L3 or below. It’s possible the patients are just mistaking low back pain from donor site pain. The two sites are too close together to separate out where the pain is really coming from.

You should discuss this concern with your surgeon before having the surgery. There are some known surgical techniques to help reduce donor site pain. The surgeon can make an incision that avoids injury to the cluneal nerve. Trauma to this nerve during surgery has been shown to increase problems with donor site pain.