spinal fusion

Lumbar Spine Fusion: Are You a Good Match?

April 5, 2013 by James Bogash

There is a time and place for surgery. I think few would argue this point. But I have seen patients have imaging, injections and surgery for cases that never should’ve been considered a surgical case.

Of course, whether or not they are a surgical case is merely my personal opinion. Since I’m NOT a surgeon, and I’m JUST a chiropractor, I could not even begin to know which cases of low back pain are or are not surgical cases. Given something as invasive, dangerous and permanent as spinal surgery, surgeons are the ones that can do the tests to definitively know whether or not a patient’s low back pain is surgical or not.

Spinal fusion involves slicing into the tissues surrounding the spinal column and then using either a special cement or titanium hardware to lock two (or more) spinal segments together so that they no longer move. The costs are staggering and the recovery, from the patient’s standpoint, is a major deal.

Again, good thing the surgeons can tell when someone needs surgery or not by doing the correct tests.

Ok. So you know where this is going. This particular study looked at just how accurate commonly used tests were at determining whether or not someone was going to have a good outcome from a spinal fusion for low back pain. Specifically, researchers looked across 10 studies to see whether these tests were actually useful:

Findings on MRI
Provocative discography (an irritant is injected into the disc; if it hurts, that must be the problem)
Facet joint blocks (the spinal joints are injected with an anesthetic; if it helps, that must be the problem)
Orthosis immobilization (using a brace to immobilize the lumbar spine; if it helps, the area needs to be fused)
Temporary external fixation (a temporary metallic brace is screwed into parts of your vertebrae)

So what did the authors say after looking at all these tools to determine is lumbar spinal fusion was going to have a good outcome?

No subset of patients with chronic LBP could be identified for whom spinal fusion is a predictable and effective treatment. Best evidence does not support the use of current tests for patient selection in clinical practice.

In other words, it’s a crap shoot.

The bottom line is that, if surgery has been recommended to fuse your lumbar spine and the surgeon looks you in the eye and says he or she is confident this is the right thing to do, it’s time to find another one. Before you go on to surgery, have you REALLY tried everything? Has chiropractic been used? Soft tissue treatments like Graston, ART or Fascial Manipulation? Yoga? Massage? Rehab?

If you can’t answer yes to ALL of the above, it’s not time for surgery. Surgery should be the absolute last possible option that you should consider because no one can predict the outcome for your situation.

CHRONIC LOW BACK PAIN TREATMENT WITHOUT SURGERY – (06-27-05)

July 8, 2012 by James Bogash

RCT to compare surgical stabilization of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain

As a chiropractor this one obviously hits close to home. When patients ask me about surgery, I usually respond that some patients with chronic low back pain may do better with fusion. Many more may stay the same and another chunk get worse. The problem is we have no idea who will fall into which category.

Quite a risk considering that the patients that do worse after surgery are really, really in bad shape. So, to find that spinal fusion is no better than an intensive rehab program (which, given that there were no DCs involved in the trial would suggest that chiropractic care was NOT part of the program) really should be the death of spinal fusion. Don’t hold your breath on that one, though…instead, breath deep and visit your local DC..

Read entire article here

I CAN’T SEE A CHIROPRACTOR–I’VE HAD SURGERY!

September 22, 2011 by James Bogash

This is certainly a phrase I’ve heard many times in the community. Usually someone stating that there is nothing that chiropractic can do to help them because they’ve already had surgery.

Obviously, seeing a chiropractor BEFORE the surgery in the hopes of avoiding the surgery altogether is the preferred method, but should you miss that opportunity, fret not. Somehow, when patients unfamiliar with chiropractic care envision a treatment session in a patient who has had surgery or maybe has osteoporosis, it involves the chiropractor jumping off from the desk to deliver a ninja-like adjustment.

I know that in our office, with the heavy soft tissue approach, we have been able to provide significant relief to those patients who have had surgery and who thought that there was nothing that could be done to help with their pain levels.

While this study is a case series and involved lumbar surgeries (the best response being those with the more invasive surgeries), we have seen both neck, ankle, wrist, shoulder, knee and low back surgeries that did not resolve the complaint but responded well to care in our office.

So, next time you hear someone say that they can’t see a chiropractor because they’ve had surgery, point out this study.

HAD A SPINAL FUSION? WAS THIS MATERIAL USED?

July 27, 2011 by James Bogash

I would have to say that in all but the most astute, few dug deep enough into their surgical procedure of fusion to find out how the surgeon was going to help the bones fuse together. As a chiropractor, obviously the idea of fusion scares the heck out of me and I fear that far to few of spinal fusion patients have undergone a solid course of chiropractic care.

Back in 2002, the FDA approved the use of a type of cement in spinal surgeries. This cement, called recombinant human bone morphogenetic protein-2 (rhBMP-2), was designed to cause your body to produce more bone to allow a faster and more complete fusion between the vertebrae that we being fused.

Sounds great, right? Unfortunately, in most of the studies conducted on this compound (the manufacturer was Medtronic and the product was called Infuse (R)) they left a little something out. Adverse effects.

Of 13 studies done by Medtronic, not a single one reported adverse effects related to the use of this compound. In this particular study, the authors took a new look at the data and found an adverse effects in 10 to 50% of the patients that received the compound. Additionally, there were very strong financial ties between the researchers of these studies and Medtronic. The authors of this current study call the original research “biased and corrupt.”

Wow. I have had a select few patients in my office who, quite frankly, we tried everything possible to keep them from having surgery and we not successful. I see a need in the right time and place for spinal fusion when EVERYTHING else has failed.

But what about the patients that were steered into spinal fusion far too soon (it is well documented that those who see a surgeon or primary care doctor first instead of a chiropactor, are more likely to have surgery)? And what if these patients had a surgery that used this compound and they were in the percentage that experienced adverse effects?

All too often in medical research the story is the same. The data is manipulated to favor the funding biotech or pharmaceutical company. The doctor or surgeon places false benefit on the product leading to recommendation to patients. It is ultimately the patient that may pay for this transgression.

The bottom line is that we need to always, always, always do our due diligence with anything being done to our bodies if it was not in the original plan by Mother Nature.