By Jeffrey R. Carlson, MD
Patients come to me for treatment guidance for their back, neck and limb pain, pinched nerves and spinal stenosis. Most have searched Google for their symptoms and available treatment options. They also may seek a second opinion from me as a fellowship-trained spine surgeon. After explaining multiple options for the treatment of their symptoms, including medications, physical therapy and injections, we then discuss the possibility of surgery. The question I’m asked most frequently is, “What type of surgery do I need?” For spinal disorders there are generally two types of surgery: decompression or fusion. These two can also be combined into a decompression + fusion surgery.
Understandably, patients are concerned that a spinal fusion will cause them to lose flexibility. They also don’t like the idea of screws and rods being left in their bodies, even though this internal bracing greatly increases the likelihood of a successful fusion. Patients with spinal bones that move too much (instability) need a fusion, as the reason a disc wears out or herniates is often related to the abnormal movement of the spinal bones. When this occurs, the patient will need a decompression to take the pressure off the nerve AND a fusion to stabilize the bones, providing a long-term solution for the disc.
Recently, the Spine Patient Outcomes Research Trial (SPORT) published their findings on surgery in patients with spondylolisthesis (bones sliding abnormally and compressing the nerves). They followed patients from 13 medical centers for eight years after their surgery. Patients having surgical decompression were compared to those who had decompression + fusion and to patients who were randomized with no surgical treatment. Over the course of the eight-year study, patients with decompression + fusion had significantly greater improvements than those who didn’t have a fusion or didn’t have surgery. During the study, a large portion of the non-surgical group of patients opted out of the non-surgical treatment and pursued a surgical option. The study recommendation highlighted that patients with instability of the spine will have a more successful treatment with spine surgery that includes a fusion.
While some patients’ diagnoses will only require removal of the pressure on a particular nerve, there are patients with instability of the bones in the neck or lower back who will have a better outcome with a fusion. Our practice has developed technologically-advanced hardware (screws, rods and plates) which provides internal bracing to the spinal bones, allowing patients to be more active during their recovery period while affording fusion rates of almost 100%. Fusions without hardware (often done in the past) required patients to spend more time in an external brace and resulted in a fusion rate closer to 60%. Just like patients with metal in their hips and knees from a hip or knee replacement, the hardware placed in the spine has a particular purpose for improving patients’ long-term function and satisfaction with their surgery.
Jeffrey R. Carlson, MD is the President and Managing Partner of Orthopaedic & Spine Center in Newport News, VA. He holds a fellowship in Orthopaedic Trauma surgery and a combined Neurosurgery-Orthopaedic fellowship in complex spine surgery from Brigham and Women’s Hospital in Boston. osc-ortho.com