Does fusion surgery work? I have blogged before about the research showing that this surgery is often no better in the long-run than no surgery. However, I’ve also pointed out that surgeons have a way of interpreting data in studies that benefit their preconceived notions of efficacy. Today’s blog is about one such study which really shows that fusion is no better than no surgery, but was interpreted by the authors that fusion is effective.
What Is Fusion Surgery?
The spinal column is designed for movement, yet the objective of a back fusion is to stop the movement of the affected vertebrae (the bones that make up the spine). The idea is that this will stop further damage from occurring, but the reality is that it just shifts more stress and pressure to the areas of the spinal column that are adjacent to (above and below) the fusion, thereby causing more damage in the process (something I call damage to accomplish a goal). This damage to the vertebrae above and below has a medical term: adjacent segment disease (ASD). How do surgeons treat ASD? Well, they often will fuse these segments as well, and from there, they are just chasing the damage up or down the spine (watch the video below for more information).
Fusion surgery is one of those surgeries we often cover because of the constant stream of research showing, most of the time, it’s just not a good idea. Let’s look at today’s feature study.
Pain, Disability, Quality of Life…No Better with Fusion Surgery than Without
While the study seems to be putting a tally mark on the side of surgical fusion, you have to dig deeper into the content. There were 294 participants who were each randomly assigned to one of two groups: a surgical fusion group and a nonsurgical, conservative therapy group. Researchers used questionnaires to collect information from the participants on a number of indicators, including pain, function, and disability. At the conclusion, the study author leads with lumbar fusion being a valid treatment for back pain, from the perspective of the patient. However, the study findings don’t seem to support this. In fact, the author ends with a statement explaining that they are uncertain whether to recommend a fusion for low back pain due to discrepancies in the measures. What are these discrepancies?
A commentary article published in The Spine Journal following publication of the original study provides some clarity. The authors labeled the study conclusion, which more heavily focused only on a singular primary outcome (function [Global Acessment], specifically highlighted in the original study as being important as it’s from the patient’s perspective) that seemed to show a more favorable response to fusion, as “highly biased” as well as “selective interpretation.” Why? The article suggests that the original investigators minimized all other findings, which showed that no differences were found in those undergoing surgical fusion versus those who simply had conservative therapies. These additional measurements included frequency and intensity of pain (VAS), quality of life, disability (ODI), and even pain-medication use, all of which are also from the patient’s perspective.
Biased Conclusions Aside, Other Studies Have Found Many Problems with Fusions
The research has continued to hammer fusions over the past few years and for good reason. The amount of fusion surgery has gone through the roof in the past twenty years, and more and more they seem to be the norm rather than the extreme. If you are considering a fusion, it’s important that you have as much information as possible so you can make the right decision for you. Are there some patients who really should get a fusion? Yes, but, in my opinion, out of every 100 patients I see who have had a fusion, only 1 or 2 really need them as there are nonsurgical therapies that would have been effective alternatives.
If you are one of the other 98 or 99, getting fusion surgery because everybody’s getting them nowadays isn’t a good idea. Here are a few reasons why:
- Fusion surgery for spinal stenosis has already been found to be no more effective for pain and function than physical therapy.
- Back fusion being no better than physical therapy was also found in the study covered here.
- Patients who underwent a back fusion due to spinal stenosis had no better outcomes at two and five years following surgery than those who just had a laminectomy (decompression, or opening up the bony area around a pinched nerve).
- After a fusion, adjacent segment disease (ASD), caused by the increased stress and pressure on spinal segments above and below the fusion, is sure to follow.
The upshot? While there are some patients out there who likely need a fusion because there is no other option, in my experience, these patients are few and far between and represent only a fraction of the patients getting these invasive surgeries, Hence, you don’t want to one of the many who gets an unnecessary surgery. Do your homework about non-surgical options!