Spinal Fusion Surgery with Implanted Hardware

The journal Spine has published an article 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, including infections which can occur more readily and can also be harder to see because the hardware can block a clear radiological view of the spine.

surgical decisions

Decisions about surgery are tough on any patient

The other problems is the hardware surviving over time.  When screws, plates or rods break, the results can push right on a nerve and the pain can be awful.

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 does 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.

Do I Really Need Back Surgery?

This is a section I am adding in 2014 because so many people are looking here and everywhere for answers.  I am not a doctor.  I’m speaking as a lawyer who has talked to hundreds motor vehicle accident patients with back problems.   This is not the take of a medical doctor.

Clearly, you should do what your doctor tells you to do.  The problem is that doctors rarely tell you that you need surgery and, when they do, it often contradicts what another equally qualified spinal surgeon tell us.   But the more common answer is that back surgery is a challenge, it can fail, and only you know the pain you are going through and only you can balance that pain against the risk.  This is not a lot of guidance.

I don’t have the answers.  But one key question to ask a surgeon is whether waiting for the surgery is going to make your injury or your prognosis worse.  Is delay causing you risk or is the reason to avoid the delay limited to the pain you are experiencing?

Ultimately, I think the key is to talk to more than one doctor not about what you should do but why you should do it.  In the end, you have to digest that advice and then follow your own heart.

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