Does Lumbar Spinal Fusion work?

Does Lumbar Spinal Fusion work?

Does Lumbar Spinal Fusion work?

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Spine technology continues to evolve,  despite the background debate on the cost and efficacy of spine surgery,  in general.  Since the early 200o’s,  the spine surgery community has been closely scrutinized by the government, and the payers of spine surgery services.

While still being debated,  there is no question that the utilization of the lumbar spinal fusion technique has seen a significant increase in the US.  Unfortunately,  for all that additional surgery,  there is very little data to support any improvement of the general health of the population.

Basic questions are still to be answered.  Does lumbar spinal fusion improve the outcomes versus simple discectomy and decompression?   When do patients with spinal stenosis also improve their outcomes when decompression is coupled with fusion?  When selecting lumbar fusion techniques,  which ones are effective?  When does utilization of cage devices in front of the spine improve the general outcome of  the fusion?  Do artificial disk replacements in the lumbar spine provide a predictable alternative to fusion?  Can our society justify the cost of spinal fusion  for certain patient populations?   Obviously,  these questions are being asked,  but the attempts at a clear answer to most of these questions often are biased by the “questioners”, or the “answerers”.  The cynic will answer  ” the insurance companies, and the government will prove that spinal fusion is not necessary”,  while “the surgeons and the device manufacturers will demonstrate the great improvements of function resulting from spinal fusion”.  I suspect the truth is somewhere in between.

So,  what do we know?  Let us assume the patient has exhausted non surgical treatments, and has  healthy enough physiology to withstand the anesthesia, and positioning required of the surgery.

In general,  it is accepted that lumbar spinal fusion works in the following scenario:

1.  One and two level spondylolithesis with evidence of instability, and stenosis.

2.  Lumbar fusion works for multiple recurrent disk herniations at the same level.

3.  After necessary aggressive decompression,  which necessitated destruction of a whole lumbar facet joint,  fusion prevents development of instability.

4.  Gross instability defined by radiologic parameters,  including increasing translation on flex/ext views,  or angular instability on these same views can benefit from stabilization.

 

To be objective,  these factors decrease the likelihood of a successful outcome:

1.  Smoking decreases fusion rates.

2.  Obesity leads to longer operative times,  with increased complications and potential for infections.

3.  Patients with psychiatric diagnoses such as depression,  bipolar syndrome, and anxiety disorders have poorer outcomes.

4.  Underlying litigation,  including disability determination,  workers compensation issues, and liability claims are associated with poorer outcomes.

5.  Multi-level diffuse disease also leads to less predictable lumbar spinal fusion outcomes.

 

While many patients are having significant back pains,  the option of spinal fusion should be reserved for patients that have the best expectation of a successful outcome.  If you are contemplating such a  surgery,  make sure you explore all your options before making the decision.

 

 

Citations

  • Jancuska JM, Hutzler L, Protopsaltis TS, Bendo JA, Bosco J. Utilization of Lumbar Spinal Fusion in New York State: Trends and Disparities. Spine (Phila Pa 1976). 2016 Oct 1;41(19):1508-14. PubMed PMID: 26977849

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Author and Contributor to www.Spine-Health.com – July, 2015

www.Spine-Health.com/author/john-h-shim-md-facs

Chief of Surgery, Mease Countryside and Mease Dunedin Hospitals, Safety Harbor and Dunedin, Florida. 2014-2016.

Orthopaedic Section Chief Mease Countryside Hospital; Safety Harbor, Florida Mease Dunedin Hospital; Dunedin, Florida.2008-2013

Board Member Morton Plant Mease Research Council

Co-Director of Mease Neuro-Ortho Spine Center Mease Dunedin Hospital; Dunedin, Florida.

One of “6 Spine Physicians Ranked #1 on Google” – December 2016

Top Ten Most Liked Spine Surgeons on the Internet – July 2016

2016 Spine Surgeons to Know list – January 2016

2014 Spine Specialists to know list – September 2014

One of Ten Leaders of Certified Spine Programs – December 2011

 

The Best Orthopedics in Tampa

The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.
Outpatient Spine Surgery Considerations. www.Spine-Health.com. January 2016.

What is Spinal Stenosis? www.Spine-Health.com. October 2015.

Surgeon insights on the Changing Landscape of Orthopedic Care. OrthopedicToday. June 2014

Chapter 33: Interspinous Spacers. Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

Chapter 35: Minimally Invasive Percutaneous Lumbar Fusion Technique.Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

March 2010 Minimally Invasive Transforaminal Lumbar Interbody Fusion American Academy of Orthopaedic Surgeons Annual Meeting New Orleans, Louisiana February 2010

February 2010 A Review of Dynamic Stabilization in the Lumbar Spine Selby Spine Symposium; Park City, Utah

November 2009 Lumbar Spinal Stenosis Community Based Lecture; Tampa, Florida

September 2009 Instructor/Proctor Minimally Invasive Lumbar Cadaver Lab; Tampa, Florida

February 2009 New Spinal Technology: Cervical Disc Replacement and Interspinous Spacers. Selby Spine Symposium; Park City, Utah

February 2008 The Degenerative Spine: The Role of Dynamic Lumbar Stablization and Interspinous Spacers Selby Spine Symposium; Park City, Utah

October 2008 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

September 2007 Emerging Technology in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

October 2006 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

May 2005 The Role of Kyphoplasty in the Treatment of Vertebral Compression Fractures Mease Neurosciences Symposium; Clearwater, Florida
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