The Risks of Low Back Fusion
Interesting study out this week concerning low back fusion surgery risks. It discusses how the surgery rate for low back fusion has jumped 1,500% from 2002 to 2007. It also discusses how the risk of a serious complication like a stroke is 5% with low back fusion surgery, versus 2% with a surgical laminectomy (decompression surgery) . It also discusses that hardware manufacturers have been using aggressive financial incentives to doctors to promote fusion over other types of surgeries. Finally, the article also brings up that there is no evidence that fusion works.
As physicians working everyday in this area, what do we think? Fusion can be a valuable tool in the toolbox for helping a limited number of patients with significant instability in the spine. Having said that, we would agree with the article concerning the sky rocketed rate of fusion in the past 5 years. I think most patients believe that this surgery will fix their back, but our interventional pain practice is made up of patients who quickly suffer side effects from the fusion. The biggest is that once you stop one vertebra from moving, the vertebrae above or below must compensate by moving more. So this eventually leads to more pain and degeneration above and below the fusion site. In addition, many of these patients end up needing a second or third surgery to fuse these levels. Do we recommend fusions? Yes, rarely, when there is no other good way to treat a patient with an unstable spinal level that is causing neurologic problems, we will recommend fusion. Out of 1,000 patients with severe spinal pain seeking an interventional pain physician, in our practice, this is about 10/1,000 or 1% or less. The conclusion, fusion is a two edged sword that can help certain patients who can’t otherwise be helped, while for most patients, it causes more problems that it solves.