There has been a significant increase in the number of people who undergo spinal fusion surgery to treat back and leg pain, but a new study suggests that spinal fusion may not be the most appropriate treatment for many of these people. The goal of the study was to compare pain relief and the ability to walk without pain in patients with spinal stenosis or stenosis and spondylolisthesis. In spinal stenosis, the spinal canal becomes narrower, pressing on the spinal cord and nerves that connect to the arms and legs. In spondylolisthesis, one or more vertebrae slide out of alignment, compressing the spinal cord and nerve roots.
The study compared the results of laminectomy, during which the surgeon removes some of the bone pressing on the spinal cord and nerves, and laminectomy and spinal fusion, during which the surgeon places a bone graft held in place by metal screws and rods to stabilize the spine after the laminectomy. Spinal fusion is a more complex type of surgery that carries additional risks to the patient and requires a longer operating time and more time in the hospital. Study participants who had spinal fusion were in the hospital for 7.4 days compared to 4.1 days for those who only had a laminectomy. Spinal fusion patients also had more bleeding during surgery and twice as many post-operative wound infections.
At follow-up appointments with the study participants two and five years after surgery, there was no difference in the amount of back pain they experienced or how far or quickly they could walk.
Is spinal fusion the appropriate treatment for you?
The answer to that question depends on a variety of factors, including how much damage there is to the spine, whether you’ve had previous back surgery, and your overall health. The first step you should take if your doctor recommends spinal fusion or any other type of surgery is to seek a second opinion from a physician who has experience treating back pain. Depending on the cause of the pain, physical therapy and other non-surgical treatments may be effective alternatives.
In addition, it can be helpful to ask your doctor these questions before choosing which treatment plan you prefer to follow:
- What is my specific diagnosis? Is it the only possible cause for my condition? What test results support this diagnosis?
- What are all the appropriate surgical and non-surgical treatments for my back problem? What are the risks and benefits of each?
- If I choose not to have surgery, what can I expect in terms of the progression of my symptoms? Does delaying surgery mean I may not be able to have the procedure in the future if I change my mind?
- If I undergo the recommended surgery and it does not relieve my pain and improve my mobility, are there additional treatments I can try?
- What complications can the surgery cause and how often do they occur?
- What is the overall success rate of this surgery?
If you do decide to have surgery, you should also ask your physician about his or her training and experience before choosing a surgeon. Find out:
- If the surgeon is fellowship trained
- How many times per year he or she performs the specific procedure you need
- What his or her success and complication rates are with the procedure