Back pain can be debilitating and can have a significant impact on your quality of life and the daily activities you can participate in. Pain in the spine often causes individuals to turn to use pain medication to try to limit the negative symptoms. Whether the pain is in your neck or lower back, spinal fusions are one of the most turned to procedures to address spinal issues. From 1998 to 2008, the number of spinal fusions performed increased from around 78,000 per year to more than 210,000 per year, an increase of almost 171 percent.
However, this treatment option has a failure rate that is significantly higher than many other treatments, it can lead to a number of health issues and spinal complications, and it does not address the underlying cause of the spinal pain, making it a less-than-ideal treatment option overall. Spinal issues following the surgery can also lead to long-term use of pain medication to address the pain.
What is a Spinal Fusion?
Spinal fusion surgeries are performed in order to eliminate pain that stems from the movement of a spinal joint. When the spine twists or bends, significant forces can be placed on the discs between the vertebrae. If these discs are damaged or in the process of degenerating, they can lose some of their height and become less able to withstand compressive forces.
With spinal fusions, this joint pain is addressed by fusing the vertebrae on either side of the affected disc to prevent motion and, in theory, eliminate the pain stemming from it. Spinal fusions can be completed in a few different ways, but all of them involve growing new bone between the vertebrae to create a continuous stretch of bone that is immobile.
During the procedure, a bone graft or synthetic bone matrix is inserted into the space between the two vertebrae that are going to be immobilized. This bone can be taken from a cadaver, from a person’s own body from the hip bone, or manufactured in a laboratory.
In addition to the grafts, hardware is placed around the spine as well. This can include metal rods, screws, and plates. These work to hold the grafts in place and to stabilize the spine while the bones heal and fuse with one another. In some cases, an additional matrix that contains regenerative cells can be placed in the surrounding area as well to help stimulate the bone fusion process.
Spinal fusions can be performed on just a single joint or for multiple levels of the spinal column. If you have just one joint in the spine fused, a decrease in spine mobility is not often noticeable. But, if you have multiple levels fused at the same time, it can be much more apparent when it comes to a range of motion and strength. These more complex fusions are generally done due to significant spinal deformities or conditions, such as scoliosis.
What are the Potential Issues with Spinal Fusions?
Spinal fusions are associated with a range of different issues, including infection, increased pain levels, a failed fusion, and more. One of the potential complications with all spinal fusions is the possibility of a failed implant. This can be a result of the bones not fusing correctly or the mounting hardware being broken or coming dislodged. The hardware can become worn down due to repeated bending or other movements. This is often more common in patients who are overweight or who have a spinal fusion at multiple levels.
Spinal fusions can also cause an injury to occur at another point in the spine. The vertebrae directly above or below the spinal fusion may be forced to withstand a larger amount of force, making them more susceptible to injuries involving the bones or intervertebral discs. This is especially more common over time, as the body tends to develop compensations similar to those that caused the original problem to occur. This can cause you to revert back to your initial levels of pain and potentially the use of pain medication on a long-term basis.
What does the Science Say?
Many studies have been done to evaluate the effectiveness of spinal fusion surgeries. One study looked at 260 patients and found that more than 29 percent of patients reported either an increase in their pain levels or no change in their pain levels at all.
Another study examined the ability of the hardware to hold up over time. They found that in 105 individuals who underwent spinal fusions, the hardware was placed incorrectly in 6.5 percent of cases and broke in 12 percent of cases. These statistics are quite high, and they were noted at just the first follow up appointment. Because of this, the rate and incidence of hardware breakage will only increase with time.
Spinal surgeries, in general, do not carry a high success rate. One study noted that only around 50 percent of surgeries are successful and that the success rate decreases significantly if you require additional procedures. They found that the second, third, and fourth surgeries were only successful 30, 15, and 5 percent of the time respectively.