The Los Angeles Times reported yesterday on a study published in the journal, Spine, questioning the use of implanted hardware in spinal fusion surgeries for back problems. The Spine study found that the implantation of hardware does not improve results. The authors also determined that the hardware carries a higher risk of complications.
It is hard to offer a lot of opinions on this without seeing the study. (Oh, yeah, and the not being a spinal surgeon part.) Also, this is just one study. But in our practice we see a lot of disc injuries and other types of back complications resulting from trauma of a crash.
Rarely does hardware seem to be a magic elixir for the patient. Nor multiple surgeries, which many times do not have a better outcome than the preceding surgery. One of our lawyers has an auto accident case in Baltimore where the client is on his 8th back surgery (no prior back complaints before the car crash). Just awful. But that is not to say that it is not medically indicated because sometimes you would rather have a 20% chance of success than a 5% chance.
The Good News
That’s the bad news. The good news is spinal surgery has come a long way. Not that many years ago, spinal surgery required a large incision and the patient was left in a body cast for six months to a year. Just last year, a spinal surgeon at the University of California performed one of the first minimally invasive spinal surgeries in the U.S. using a new technique to stabilize the lumbar spine called axial lumbar inter-body fusion. The fusion requires only a tiny incision in the back and can have patients up and walking with little pain within hours of leaving the operating room. Absolutely incredible.
Interestingly, the fusion is done in the front of the spine without having to go through the abdomen. The technique was developed 5 years ago by an interventional radiologist. The first surgeries were performed in Brazil, where 33 patients have been operated on since the technique was introduced there in 2003. The Food and Drug Administration (FDA) only recently approved the procedure for use in the U.S.
Who knows what the long term prospects for these patients will be? But many of the early returns have been very positive. Hopefully, the next ten years will provide a lot of relief for patients with chronic back pain.