Confusion over Spine Fusion

Orthopedics ׀

Between 1996 and 2001, the annual number of spine fusions rose by 77%.

Although the authors realize that many good and necessary reasons exist for spine fusion, such as infection, deformity, and spondylolisthesis, they question its use in discogenic pain and spondylosis. A 2001 Swedish study, which compared one-or two-level fusion with conservative treatment, found a greater improvement in discogenic pain following surgery. However, only 63% of the surgical group believed the pain to better. An average 30% improvement in function was reported. Only one in six patients were completely pain free. Spine fusion outcome is difficult to assess. It is not easy to confirm a solid fusion and its relationship to pain relief. Pseudarthrosis may be associated with pain relief and solid fusion sometimes not.

The authors note evidence for a higher fusion rate with pedicle screws over simple bone grafts, but screws gave no clinical advantage. They also list higher rates of reoperation with screws, nerve injuries, longer operation time, greater blood loss, and other complications. In this review, instrument failure was 7%, bone donor site problems 11%, neurological injuries 3%, and infections, 3%. The pseudoarthrosis rate is listed as 15%.