Why Spinal Fusion Surgery Often Isn’t the Best Option for Low Back Pain

The discomfort of lower back pain plagues almost all of us. In fact, a staggering 80% of Americans will encounter lower back pain at some point in their lives. Those who suffer with it also experienced reduced hours of productivity, lost wages, and even unnecessary surgeries.

What’s all of this pain costing us? Back pain treatments cost Americans $50 billion last year alone, with a large portion of those dollars going toward spinal fusions. Half a million Americans get spinal fusions each year, and those numbers are only poised to increase.

A lumbar spinal fusion is a procedure where two vertebral segments are fused together. The segments are fused together with bone, either from the patient, a donor, or an artificial bone substitute. The goal is to immobilize movement at the joint in order to stop pain.

Despite the fact that the number of spinal fusions are on the rise--at alarming rates--many patients are throwing away their money, as well as hopes, on ill-recommended spinal fusions for lower back pain.

Cervical Disc Surgery for disc fusion is significantly different. While the majority of people with pain from cervical disc disease can get better on their own over time with conservative, non-invasive treatment, many will still require surgery if the other treatments fail or if symptoms worse. Neck pain from a herniated disc, arthritis, or bone spurs can progress to pain and numbness in the arms derived from pressure on the cervical nerve roots.

When we perform surgery on a disc that is pinching the nerve or pressing on the spinal cord through an anterior cervical discectomy, patients report positive outcomes.

In contrast, Lumbar Spinal fusions have consistently shown to be a controversial treatment for low back pain. In fact, spinal fusions for lower back pain were just added to a list of ineffective treatments published by Choosing Wisely, an organization that focuses on the education of medical professionals on effective and ineffective treatments.

Why? In some randomized studies, spinal fusions for lower back pain proved only slightly advantageous over other methods, such as rehabilitation. Additionally, doctors disagree on the true success rates of spinal fusions for lower back pain.

Furthermore, doctors continue to disagree on exactly when these spinal fusions should be performed, leaving no clear cut treatment plan. Instead, the decision varies widely from doctor to doctor and patient to patient.  

Any surgery should always be weighed carefully, and spinal fusions are no exception. Spinal fusions are expensive, and 1 in 5 people who have lumbar spinal fusion surgery will need to go back under for revisions within the decade.

If you are suffering from lower back pain, spinal fusion surgery should not be the only answer for you. Lumbar spinal fusion can be an ineffective procedure and must be considered carefully with other options and on a patient-by-patient basis.

If your doctor recommends lumbar spinal fusion surgery, make sure you review with your doctors all options, including exercise, rehabilitation or other methods of treatment. They could be more effective, less expensive, and have a greater success rate.

Dr. Donald Hope