RIP Back and Neck Fusions
Back in the day, when I graduated from Physical Therapy school, most back surgeries were laminectomies and spinal fusion was pretty much unheard of as a procedure. The laminectomy was used to surgically open up the bony area pinching the nerve. About 15 years ago, fusions became more and more common and in the last few years most people who undergo spine surgeries have a fusion. Understand that the spine was built to move at each of the 24 levels and during the fusion one or more of the levels are bolted together with screws, plates or spacers.
Why have spinal fusions become such a popular surgery? We do not have high level research showing that fusions have significant improvement over a laminectomy. Fusions do however increase the payment from the insurance companies. Not to mention we can now charge a lot of money for a $5 screw made in China.
The downside to the fusion surgery is that it prevents the spine from moving at one or more levels. The spine, however, wants to move, so the adjacent segments will pick up the slack which causes them to wear down. It is not unusual for a person to need another spinal fusion due to the increased wear and tear above and below the initial fusion.
Given how much the surgery costs and the invasiveness of the surgery and the additional breakdown of the other joints, you would think the evidence surrounding the surgery would be incredible. Nope. The New England Journal of Medicine just recently published the world’s first randomized controlled trial of lumbar fusion. In the study, some people had a laminectomy and others a fusion.
The result was that adding a fusion did not improve the outcomes at two or five years after surgery.
I have been treating people after fusions for many years and it is scary that we are exposing people to a much higher surgical risk as well as significant potential to need further surgery without improved outcomes. This study really makes you wonder whether to return to the basics – like exercise – to overcome back pain.