14 Jun Studies Say Spinal Fusion Surgery Not Always Necessary
New clinical trials in Sweden have recently shown that spinal fusion may not always be the right choice for patients suffering from spinal stenosis (a painful condition caused by a narrowing of the spinal canal). A simpler procedure called spinal decompression may be a better option, offering a similar level of pain relief but with fewer complications. Doctors debate which treatment option is best for patients with certain spinal issues like spondylolisthesis, but the latest studies have suggested a conservative approach and surgical options customized for each patient.
Spinal decompression surgery is most appropriate when nerves exiting the spinal column are being pinched (neural impingement). During a lumbar spinal decompression procedure, bits of bone over and under the root of the pinched nerves are removed to give it more space. Once the bone tissues are removed, irritated nerves can begin to heal. Both microdiscectomy and lumbar laminectomy involve a spinal decompression procedure designed to give nerve roots an unobstructed path to take as they exit the spinal column. Spinal decompression is a relatively simple procedure that specifically addresses nerve irritation.
On the other hand, spinal fusion is a surgical procedure that stops mobility at a painful junction between vertebrae by fusing junctions with bone grafts. It’s a useful procedure when a patient has a slipped disc, for example and doctors tend to prefer it over spinal decompression.
Rods, plates, or screws prevent shifting until the grafts are healed. By fusing the vertebrae, pain caused by movement diminishes. But spinal fusion is a much more complicated surgery than spinal decompression. Spinal fusion surgery takes longer to perform and patients must also stay in the hospital longer too. The cost of spinal fusion is therefore higher as well. Spinal fusion involves bone grafts or a boney fusion which are inherently more complicated and subject to failure than the decompression procedure that involves only the removal of bone.
Though spinal fusion may still be the best choice for certain patients, those with low-back pain caused by pinched nerves due to a vertebra that’s slipping forward (lumbar spondylolisthesis) should consider spinal decompression instead. Pain in the lower back is often the result of aging and the degeneration of discs, joints, and ligaments in the spinal column.
A variety of processes contribute to the narrowing of the spinal column and the crowding and compression of nerves that cause pain as a result. Many doctors do both spinal decompression and spinal fusion procedures at the same time. But spinal decompression surgery alone offers salient benefits including lower hospital bills and less time spent in surgery and in recovery at the hospital.
Spinal fusion patients averaged about 7.4 days of hospitalization versus 4.1 days for the spinal decompression group. Fusion patients were also in the operating room longer and they lost more blood too. The surgical costs were higher for patients undergoing spinal fusion than those undergoing decompression.
But four years following surgery, patients who had undergone spinal fusion had a significantly higher quality of life in comparison with spinal decompression patients, according to some studies. Despite this, experts suggest that the decision to use one procedure over the other needs to nuanced and customized based on each patient’s individual needs. Spinal fusion isn’t always necessary. Sometimes, spinal decompression may indeed be a better choice.