Though increasingly used for the treatment of herniated disks and spinal stenosis, spinal-fusion surgery benefits only a small subset of patients.
The use of spinal-fusion surgery has increased drastically in recent years, from 150,000 procedures in 1993 to 300,000 in 2001. Although many long established uses exist for spinal fusion -- for the treatment of severe scoliosis, spinal tuberculosis, and vertebral fractures -- doctors are increasingly using spinal fusion to treat back pain resulting from degenerative changes in the spine, disk disorders such as herniated disks, and spinal stenosis. However, there is no convincing evidence that spinal fusion works for most patients with back pain from these conditions.
Why, despite little evidence to support it, do doctors consistently recommend spinal fusion surgery to their patients? The answer may lie in part with what some have called a “triumph of technology over reason.” Because the technology of spinal fusion has advanced enough that the surgery can be done relatively safely, surgeons may be quicker to suggest spinal fusion than they were in the past, even if the patient is not an excellent candidate for the procedure. The attitude may be that “it can’t hurt to try.”
There is some evidence, however, that spinal fusion may help a very select group of patients. According to a study published in Spine of 294 patients with chronic low back pain, back pain was reduced by 33% in patients randomized to receive spinal fusion compared with 7% in those undergoing physical therapy. However, to achieve success, the authors of this study point out that patients must be carefully selected for spinal fusion surgery and well informed about its potential outcomes.
If your doctor recommends spinal fusion for treatment of degenerative changes, a herniated disk, or spinal stenosis, how do you know if you’re actually a good candidate? First, you should have severe disability from your back pain -- for example, being unable to perform activities of daily living (such as dressing or bathing yourself) or to do your job. Second, you already should have tried conservative care -- such as self-treatment, pain relievers, and exercise -- at least for six months without success. Third, the back problem should be localized, that is, confined to a small area (one to two levels) of the spine, with no associated deformity.
The Bottom Line -- Although studies have not clearly shown that spinal fusion is effective for spinal degenerative changes, herniated disks, or spinal stenosis, some people with these conditions report pain relief from spinal fusion. Deciding who will benefit most from spinal fusion surgery requires a careful analysis of the patient’s particular situation -- both physical and psychological. To reduce your odds of undergoing a surgical procedure that will provide no benefit, get a second opinion before yielding to the knife. Also, many doctors now increasingly consider disk replacement as an alternative to spinal fusion.
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