Is Spinal Fusion More Trouble than It's Worth?
There is evidence of high complication rates associated with lumbar fusion, and a relative lack of evidence demonstrating the effectiveness of the procedure for most degenerative spinal conditions.
A review of 6,376 records of patients who underwent lumbar surgery (1,041 of whom underwent spinal fusion) reported that 18% required reoperation during the five years after the procedure was performed, and that complications were more frequent among fusion patients compared with laminectomy and discectomy patients.
Reoperation rates over the five-year period were slightly higher for patients in the fusion group (18.2%) compared to the nonfusion group (14.6%), while complication rates, lengths of hospital stay, and average inpatient costs after surgery were substantially greater for patients whose operation incorporated fusion (18% of fusion patients reporting in-hospital complications compared with only 7% of nonfusion patients).
These results emphasize the need to examine whether potential long-term outcomes outweigh the short-term risks and costs associated with spinal fusion procedures. Nonfusion surgical procedures (i.e., laminectomy or discectomy) or alternative, nonsurgical interventions may prove more effective.
Malter AD, McNeney B, et al. 5-year reoperation rates after different types of lumbar spine surgery. Spine
, March 1998;23(7), pp814-20.