Tuesday, February 22, 2011

More evidence against the use of spine fusion surgery

A few months ago I blogged about the rise in the use of spinal fusion surgeries. You can see this post here. The basic gist of the post was that the evidence clearly demonstrates that spinal fusion surgeries don't work, but doctors are continuing to use the technique anyway.

I've come across more evidence that spinal fusion surgeries are not ultimately helpful to injured workers, as opposed to other more conservative treatment. This study was performed specifically with injured workers. You can see the full article, with related links, here. Also, here's an interesting review of the evidence and it's implications from the excellent blog Workers' Comp Insider.

At a time of continued debate over the role of spinal fusion surgery (lumbar arthrodesis), the results suggest that this operation "may not be an effective operation for workers' compensation patients" with certain causes of low back pain. The lead author was Dr. Trang H. Nguyen of University of Cincinnati College of Medicine.

Using Ohio workers' compensation data, Dr. Nguyen and co-authors identified 725 workers with chronic low back pain who underwent spinal fusion surgery. Spinal fusion is an operation done to fuse together adjacent vertebrae in certain types of chronic back problems. Most of the patients in the study had degenerative disc disease, herniated discs, or nerve root disease (radiculopathy).

The researchers assessed the final treatment outcomes—including return to work, disability, and use of strong pain medications (opioids)—at two years' follow-up. They compared the results of spinal fusion with those in a random sample of 725 patients who underwent nonsurgical, conservative treatments (such as physical therapy, exercise, etc).

Almost all categories of outcomes were worse for patients undergoing spinal fusion. Just over one-fourth of spinal fusion patients had returned to work, compared to two-thirds of those treated without surgery. Twenty-seven percent of patients in the spinal fusion group had repeat surgery, while 36 percent experienced some type of complication.

The use of spinal fusion surgery for chronic low back pain has increased dramatically in recent years—despite a lack of consistent evidence that it improves patient outcomes. Few previous studies have looked at the use of spinal fusion surgery, compared to nonsurgical treatment, in workers' compensation patients.

Although it's not a controlled scientific trial, the study raises questions about the long-term effectiveness of spinal fusion surgery for workers' compensation patients with chronic low back pain. Dr. Nguyen and co-authors write, "This procedure is offered to improve pain and function, yet objective outcomes showed increased permanent disability, poor return to work status, and higher doses of opioids."


Phenocane said...

Ohh, It's so painful that spinal fusion surgeries don't work, but doctors are continuing to use the technique anyway.

Anonymous said...

Really,Spinal fusion surgery is so painful. Thanks for linking up!!

Anonymous said...

I had fusion l4,l5 and s1 on may11 2011 I feel 100% better.Dr Scott Webb in Clearwater Fl.He did so well that I only had 3 physical therapy visits and I was on my own.He is terrific.very painful for a couple of weeks,had to cut through some muscles.I have a cage and 4 screws.People are all different but if you have a good surgeon like dr Scott Webb and you do your part,it can do wonders for your pain.

Anonymous said...

My husband had his first fusion 8 yrs (L4 &5) and has done great. He knew that L3 was bad then but has just had the fusion in 9-11 for that and again has done great. He had wonderful surgeon (neuro)at Wake Forest Baptist in N.C. He is now 59. I think alot of it depends on surgeon.

Rhino said...

This was a very interesting article/ post. I've been dealing with my problem for 9 years now. Injured while working as a cop and lifting a patient to aid the Paramedics, I went throught the L4 to S1 fusion a year and a half later. I still have no relief and my next thing is an epidural injection. Tons of meds, PT, accupuncture, etc. and no relief. I actually just started blogging the other day to share some of what I learned about the whole process. (http://workerscompbackinjury.blogspot.com/2012/11/the-beginning.html)

Still getting jerked around by the comp carrier, too. But I have to say that my surgical team was great. Drs. John Beiner, Patrick Tomak and a vascualr surgeon whose name escapes me, were all highly qualified and the surgical part of my treatment was flawless- it just didn't fix what is causing my pain.

Thanks for sharing your information!