Spine fusion back surgeries, mostly performed for chronic back pain, have been shown to lead to increased rates of permanent disability in a recent study reported in the journal Spine.
Researchers in Ohio, United States, compared over 700 people who had their back pain treated with spinal fusion surgery to the same number who were managed with physiotherapy and exercise. Around two thirds of patients in the non-surgery group were back at work after two years but only a quarter of the surgical group.
There were a series of problems with the operated group:
- They used far more opioid painkillers
- There was a high level of surgical complications
- They had a 27% re-operation rate
- The days off work overall were 1140 compared to the other group's 316
- 11% were permanently disabled compared to 2% in the non surgery group
In the US the use of spinal fusion back surgery has increased 220% since 1990 as quoted in the paper. These operations are risky and not seemingly more effective than conservative management, yet larger and larger numbers of people are opting for them.
Spinal specialists have known for years that operation can be helpful and the results are quicker but that in the longer term operated patients may not be any better than patients managed by conservative means.
The management remains: rest little, keep active as possible, stay at work if you can, go back to work asap of you are off, do not expect your back pain to be absent before you return to work, attend physiotherapy and gym work to strengthen up and build confidence.
What is remarkable is just how bad these results are in the study. The limitations of the study mean that everyone is not going to stop operating on these patients, but it should definitely give them pause. And you if you have been offered spinal fusion.
Hammersmith physiotherapists understand the management guidelines for back pain and are able to guide patients through exercise programmes and rehabilitation to speed return to work and reduce the chances of disability.
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