Spinal fusions can be a highly effective at relief of painful symptoms of the back and the neck. Reliably attaining a solid spinal fusion has increased in the past 2 decades due to advances in implant technology and surgical techniques. However, there is considerable controversy regarding spinal fusions effectiveness, risks and costs. This controversy has arisen, I believe, due to several factors. One is the increased use of spinal fusion for pain arising from the disc itself, apart from any effect on the nerves. Fusions are generally well accepted treatments when addressing instability, deformity and trauma but trying to use spinal fusions to address all of the painful joints of the spine has led to many clinical failures. It is not that chronically painful discogenic back pain (arthritic back pain arising from an injured disc that is still moving and protecting the nerves adequately) cannot be improved or cured with spinal fusion. It is just that the chances of getting a cure from the procedure is statistically less certain. In addition, the fusion of one or more discs creates additional stress to adjacent disc which seems to contribute to the adjacent disc wearing out sooner than it otherwise would have.
The reputation of spinal fusions was further damaged by the advent of disc replacements. Disc replacement held the promise motion preservation. In order to sell it, they emphasized the risks that fusions have at increasing the risk of wearing out at adjacent levels. Disc replacement technology is relatively new and the idea holds considerable promise. However, as with any new technology, it takes time to perfect. The early studies on disc replacement were equivalency studies which mean that they were studied to see if they were equivalent to the outcome of a spinal fusion for the same condition. The spinal fusion that they used to compare to had already been abandoned by most spinal surgeons because of the high failure rate of that particular technique. Still, the FDA liked it because they had good data on it from previous Investigational Device Exemption studies and the procedure was otherwise similar in that it was performed through the same incision single anterior incision. Results in the lumbar spine have been lackluster and it remains unclear if the risks of the procedure outweigh the possible benefits. Fast forward 20 years and there are still a hundred fusions procedures performed for every disc replacement. Cervical disc replacement are much more promising. Outcomes are superior to fusion with proper patient selection and newer designs seem likely to provide better long-term outcomes.
In short, current technology and good surgical technique make achieving a stable spinal fusion a very reliable operation. That does not mean that there are not consequences to fusing the spine together. The decision to perform a spinal surgery needs to be considered carefully as it changes the mechanics of the spine. It is not risk free. Nothing is, but it can still be a very useful procedure in providing pain relief from many chronically painful spinal conditions.
If a spinal fusion needs to be performed then it needs to be performed with the goal or restoring and optimizing the position and alignment of the spinal segments. One needs to treat every fusion as a deformity surgery, restoring balance. If you are fused out of alignment the chances of transitional degeneration and the need for additional surgery go way up.
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Texas Spine Consultants Addison
Legacy Orthopedics & Sports Medicine
Texas Spine Consultants
17051 Dallas Parkway
Addison, Texas 75001
Mon. 1:00pm – 5:00pm
Wed. 8:00pm – 5:00pm
Fri. 1:00pm – 5:00pm
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Parking: Use the open parking lot at the back of the building or FREE valet parking is available.
Legacy Orthopedics & Sports Medicine
6501 Preston Road
Plano, Texas 75024
Mon. 8:00am- 12:00pm
Fri. 8:00am- 12:00pm