The many of us who work in the field of medicine know too well that in many instances the remedy could be worse than the disease. As a neurosurgeon for the last fourteen years I have had to personally deal with this painful issue many times. Take for example when I had to perform emergency life saving procedures on patients where survival in a vegetative state would be worse than a peaceful death. But there are also other examples in other fields such as radiation therapy for terminal cancer (of course except when it is used for pain control) or when drugs for obesity use have turned deadly.
Lumbar fusion for degenerative disc disease is a well known treatment for back pain. Desperate patients with low back pain and spine surgeons equipped with technical expertise and a good will, have all fell to this trap many times. Low back pain is one of the most difficult conditions to treat successfully and I have to say a “cure” is rare to see. The procedure involves fusing segments of the spine to alleviate back pain. The problem is that in many instances, perhaps in up to fifty percent of the time, it does not work and it can actually make the pain worse. Since the procedure is one of the most common performed today, pain clinics are full of patients who now require several hundred pills a month, to control their painful condition.
As a surgeon who has performed more than a thousand fusions I can testify that in general the operation is morbid (and yes, I am well aware that preceding statement would raise eyebrows and make me unpopular among my colleagues). The literature is full of scientific papers on both sides of the isle however the truth is in the offices of the primary cares and pain doctors. The good outcomes belong to those doctors and patients who select the role of surgery very carefully. Patients that tend to do well include those with instability, fractures or infections. Of those with degenerative disc disease (DDD), only half with single level disc disease, a few with two-level or three-level DDD would benefit from the fusion surgery for more than a couple of years. Other factors such as smoking and age also play a significant factor in achieving good outcome. By these measures, only a few patients are a reasonable and good candidate for lumbar fusion, yet we see a large number of fusions performed on a daily basis.
Several “spine surgeon” with no proper training in the field of spine surgery are entering this arena of high complexity. Unless we educate the public in the role of fusion and get them involved in their decision making, the problem is likely to grow in the next few years and many more people will be applying for disability benefits.