Spinal Fusion surgery is becoming more common in Australia prompting fellows of the Royals Australian College of Surgeons to voice their concern that it is set to become the new standard of care for chronic back pain.

They are worried that patients who are not good surgery candidates are receiving the operation under misplaced belief that it is the best course of treatment. Spinal Fusion surgery is a tough operation with an extended recovery period that never results in a total cure. So, why are people turning to the operation?

What is chronic back pain?
To get to the bottom of the issue let’s first explore chronic back pain. It is more than a twinge or feeling of tightness when getting out of bed each morning. It is a debilitating condition that puts sufferers in severe pain – constantly. In many cases sufferers are unable to continue working, let alone do everyday tasks like lift and carry children, raise their arms to put groceries away in high cupboards or reach across the table for a glass. With a spinal injury mobility is damaged or even lost below the affected vertebrae. Often this means the legs, pelvis and hips are unable to respond to commands to walk, bend, twist and pivot. Experiencing this type of pain and incapacity for twelve months or more is supposed to be one of the first steps towards qualifying for spinal fusion surgery.

Spinal Fusion Surgery
Spinal Fusion surgery can be used to assist patients with damaged vertebrae and slipped discs. In these cases pain comes from irritated nerve endings around the disc, bone, or joints themselves, or it may be due to actual entrapment of the spinal nerves in that region. In hope of improving the level of pain the surgeon quite literally fuses the damaged vertebrae together. Depending on the patient’s unique requirements titanium pins are used to fuse the vertebrae, or bone grafts taken from the pelvis. The operation can be performed through incisions made on the back, side or front of the abdomen.

Recovery
Recovery from spinal fusion surgery can take months; months of dedicated recovery treatment. A good candidate for spinal fusion surgery is someone that has put in the work to attempt overcoming their back pain prior to the surgery taking place because they will need to draw on the same resources of inner strength to get them through the post surgery phase if they are to get the receive long term benefits of the operation. In fact, in the short term there is unlikely to be any decrease in pain at all. Some patients are required to wear a corset or brace for weeks to months after the surgery and there will be a time of reduced mobility as the spine heals. They must also adhere to physiotherapy and rehabilitation exercise and diet regimens.

Why are more Australians opting for the surgery?
A review into spinal fusion surgery reports that “patients were presenting with high expectations of modern medicine, and in many cases there were additional entitlements to monetary gains from workplace injury compensation and third-party incidents”. There appears to be a gap between what patients expectations and the reality of surgery. There is also a gap between published medical trials proving the viability of spinal fusion surgery. A 2005 review was critical of the spinal fusion outcomes as there was limited evidence of the long-term effects. The need for medical trials still remains.

What can patients do?
Patients with chronic pain deserve a solution. If your doctor suggests spinal fusion surgery consider it, but also do your own research, seek out second opinions and ask as many questions as you need to feel satisfied that spinal fusion surgery is the best option for your particular circumstances. Ask yourself if you have tried other treatments including physiotherapy, exercise and CBT. Even if they don’t give the desired results they will provide a foundation to aid recovery from surgery. Spinal fusion surgery is a serious operation that doesn’t promise a cure, but offering a reduction of strong pain.

A 2005 review was critical of the spinal fusion outcomes as there was limited evidence of the long-term effects of either surgical decompression or fusion remained a matter of concern, given the numbers and the costs of the surgical procedures being performed.

Further information:
http://www.spineuniverse.com/treatments/surgery/what-should-know-about-lumbar-spinal-fusion
http://www.doctorportal.com.au/mjainsight/2016/15/spinal-fusion-surgeries-questioned/