What's behind the rise of spinal fusion surgeries?
One back surgery trend alarms many experts: Spinal fusions have increased 105 percent from 2000 to 2009, according to the latest CDC numbers. While the surgery joins vertebrae together, some studies show success rates — reduction or elimination of pain — as low as 47 percent.
“It’s not the fusion operation that’s bad,” says orthopedic surgeon Dr. Eugene Carragee at highly rated Stanford University Medical Center. He says the problems are a result of doctors performing fusions on the wrong patients. The procedure can be helpful for those suffering spinal instability, or abnormal movement between vertebrae. Experts agree the term is vague, causing confusion over who’s the best candidate.
“We all define instability differently,” says Dr. William Abdu, medical director of the Spine Center at Dartmouth-Hitchcock Medical Center. Even if doctors had a clear definition, he adds, imaging still doesn’t identify the source of the pain and doctors could choose the wrong surgery. “Patients are left with making a very important decision based on imperfect information,” Abdu says.
A study published in the Journal of the American Geriatrics Society reveals much of the increase in fusion’s popularity comes from older adults doing it in combination with laminectomy for spinal stenosis, or narrowing
of the spine. Carragee points to improvements in surgical techniques and new medical devices. The surgeries escalated beginning in 1996 when the FDA approved the first “fusion cage,” a new generation of surgical implants.
He says money is also a motivating factor. Doctors receive about four times more for a fusion than a laminectomy, which may be more suitable for patients without instability.