CBS recently highlighted the fact that spinal fusions are increasingly common procedures and that indications in some cases are controversial. Their highlighting of “surgeons they looked into” presents a frightening picture of alleged abuses, of a procedure that in many cases is clinically indicated with excellent results.
The controversy regarding fusion typically relates to its use in patients with chronic back pain of uncertain origin. For many non degenerative spinal conditions such as fractures, tumors, deformity, instability and infections there is no controversy about fusion surgery. Most diagnoses with a degenerative component including, but not limited to, adult degenerative deformity, spondylolisthesis and certain cases of spinal stenosis and disc degeneration have strong supporting evidence. The controversies in the CBS report surrounds a few surgeons widely offering patients with chronic back pain syndromes fusion surgery in the absence of a clear indication.
The International Society for the Advancement of Spine Surgery (ISASS) which has its annual meeting next week is in agreement with the tenet of the CBS review that spinal fusion should only be performed for strict clinical indications. We are concerned that patients when casually reviewing the information as presented may end up with the wrong conclusions regarding what in many cases is an excellent and necessary and clinically useful procedure. Patients do need to carefully consider alternatives before agreeing to a procedure such as a spinal fusions. A well-informed patient and a well-trained surgeon can together decide whether the fusion is the best treatment alternative for their underlying spinal condition. The International Advocates for Spine Patients (IASP) is an international organization partnering physicians, patients, and the medical industry to advocate for high quality, widely accessible and cost effective spine care for patients around the world. International Advocates for Spine Patients (IASP) a sister organization, has gathered many success stories of patients who have benefited from such surgeries and provides patient updates on their Facebook page.