According to a new study 1 in 5 patients who opt for lumbar fusion surgery will need a second within 4 years after their first. Do you know why we, as chiropractors, as well as the best surgeons in the area will suggest avoiding surgery till it’s absolutely necessary? This study right here is the reason. It is common for a patient who undergoes one spine surgery to require another at some point in their future. The condition that contributes to this is caused adjacent segment disease.
A lumbar spinal fusion is a surgical technique to treat a number of spine and spine related disorders. In this procedures surgeons use various techniques, many using metal implants, to fuse two or more vertebrae of the spine together. The vertebrae that are fused together can no longer move and as a result any pain associated with these joints not moving properly should resolve. The purpose of spinal fusions also becomes a problem for the spine that can result in the condition called adjacent segment disease.
Adjacent Segment Disease (ASD) occurs at a joint above or below the vertebrae that are fused together. As a result of the fused segments no longer moving, increased load bearing and stress is placed on the segments that were not fused and can still move. Over time that stress causes those healthy joints to breakdown and potentially become the source of pain and loss of function. This is adjacent segment disease and may result in a surgical revision to fuse the once healthy segment to the previously fused segments.
What this new paper is showing is that within 4 fours 1 in 5 patients who had a lumbar spine fusion required a second lumbar spine fusion. The authors did note that, for treating the patients initial symptoms, the first surgeries were successful. They only had a small number of cases that a second operation was necessary for treating the initial symptoms or due to a failure of the surgery. The authors also noted that a second surgery does not have the same rate of success as a single surgery. They conclude that care must be taken to ensure surgery is the best course of care and all the risks are discussed with the patient prior to getting the patients approval to proceed with surgery.
I cannot count how many patients we have treated over the years who regret having had spinal surgery, the number is high. Thankfully, due to better surgeons and practices, fewer patients are being talked into surgery unless it is the last resort or absolutely necessary. We benefit from working with the best neurosurgeon in our area who is conservative in his recommendations for surgery. If he recommends surgery for one of our patients, I trust that recombination 100%. I can count on one hand the patients of ours he has had to perform surgery on despite sending a number of our patients to him for consultation.
All this to say surgery is sometimes necessary but we should do our best to avoid it at all costs because surgery doesn’t always result in a great pain free rest of your life. A 1 in 5 reoperation rate within five years is not very good and you have to wonder what the reoperation rate is over the four years after that. Don’t make the decision to have a lumbar spine fusion lightly, that decision will have a huge impact on your future health and quality of life.