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Doc recommends spinal fusion from T12 - S1.
Spine Health | Last Active: 57 minutes ago | Replies (95)Comment receiving replies
I have been told repeatedly that surgery is almost never done because of an MRI but rather symptoms in combination with imaging. It seems logical to base a decision about such a major elective surgery on evidence based research. I keep searching for that and as of yet have not been able to find it. Of course, everyone is different and no surgeon can promise a particular result but I am not clear as to why I cannot find consistent clear statistics based on high quality research. I believe there is an indication that back surgery for severe leg pain can be very effective but that’s about it. A lot of the higher quality international research seems to suggest fusions are generally not more effective for the lumbar spine then decompression without fusion and that the stats for instability following surgery is similar after a few years regardless of the procedure.
My husband is a researcher and said the overview i posted of available research was very thorough.
Replies to "I have been told repeatedly that surgery is almost never done because of an MRI but..."
@kdks99 I wanted to acknowledge your position about looking at research. If you wish, you may post links to spine research you find if you want to bring that into the discussion. Some of the sources I use in looking for medical studies are Google Scholar, and I look for studies that come from respected medical centers. I've also learned a lot by watching spine surgeon's presentations online at the Seattle Science Foundation. Some information is freely available, and some requires a fee. I also like to look at research, and in doing this, I was able to find my correct diagnosis of my spine symptoms that had been missed by 5 surgeons before I came to Mayo. I had a single level fusion at C5/C6 for spinal stenosis that was causing pain all over my body and loss of coordination in my arms, and other symptoms. In my case, surgery improved my life a lot, and stopped the progression toward disability. Medicine is always changing with new discoveries, new implants and new procedures, and as patients we are all different too, different spine conditions, different ages and health statuses, etc. We do need to learn as much as we can and be our own best advocate. With spine surgery being elective most of the time, patients are making the decision when to go forward with surgery after weighing the benefits and risks.
Is there something in particular that you are looking for in medical studies? Are you facing a decision about surgery and looking for data to aid in your decision?
Jennifer
Dear kdks99 - I understand your frustration in trying to find exact, well-researched, complete with statistics spinal research information. I spent countless hours looking for data like that which would tell me what I could expect. Never found it...
The challenge is - as you realize - every person is different, every spine problem is different, every surgeon is different, every medical facility is different, every surgical procedure is different - (I am working to gather a definitive list of spinal surgery options and my partly completed research shows nearly 30 different legitimate spinal surgeries being employed by the medical community).
Simply put: there are too many unique variables to publish any sort of absolute spinal surgery statistics.
In my case, a combination of MRI and X-ray indicated the need for surgery more than 20 years ago. I consulted with an internist, a neurosurgeon, and a close friend who already had spinal surgery. All three said the same thing: Unless you're lying in bed screaming in pain (literally their words) defer spine surgery as long as possible while being mindful that permanent nerve damage can result and should be avoided.
Once I started experiencing obvious symptoms of severe nerve impingement - dead legs in my case - on a daily basis, new MRI/X-ray results indicated that the risk of permanent nerve damage was approaching so surgery became the next best option.
As I mentioned at the top. It's frustrating to make that sort of momentous decision without the hard science data you'd love to have. My suggestion: Be systematic in your consideration of alternatives and view a decision regarding spinal surgery as a personal risk/return analysis.
Are you about to make the decision for surgery? What is being recommended?
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I totally agree that an abnormal MRI itself is not an indication for surgery As I said the vast majority of people older than 50 will have abnormal pathology with absolutely no symptoms Further most people with LBP respond to conservative measures My point was, and I wrote this, this is in association with people with severe stenosis, claudication and nerve compression. Those were reflective of symptoms. Left alone they can cause considerable damage I never implied that only MRI was used alone However your comment sounded like you were dismissing surgery almost all altogether and that you have failed to find any research that says otherwise I included research that explains that surgery can be the only option in some cases -not in all cases It appears we are both saying the same thing now that you’ve clarified your comment I’m sorry I made you feel defensive