Doc recommends spinal fusion from T12 - S1.

Good morning I’m sorry that you were facing such an intensive surgery. Forgive me if you’ve already done this, but have you had second opinions before undergoing such a radical procedure? I have had five different spinal fusions so I understand not being able to do the things you want to do. I had a doctor in the teaching hospital in Miami tried to fuse my entire cervical spine, and was warned by two neurosurgeons that I would have lost all range of motion in my neck and it could have caused much more severe pain. Good luck to you.

I am always looking for high quality research to enable me to make good decisions about potential surgery. This is as good an overview of RCTs for the lumbar spine. As you will see there is very little evidence based research in this area to support most surgical interventions. Hope this helps you ask questions and ponder the "best" path. https://onlinelibrary.wiley.com/doi/full/10.1111/imj.14120

This study is focused on common LBP and itself states that the research they looked at was poor. Almost all adults over 50 will have spine pathology, it's the nature of aging and most of those persons will not need surgery and can be treated conservatively. But when an adult has radiculopathy, neural claudication or severe stenosis, then surgery is typically the only treatment available. I don't know your status and this woman's MRI does not look particularly bad, but please don't use this study to discount all lumbar surgery. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5685967/

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.

Thank you!

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

@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?

Thank you for your thoughtful response. I take issue with your premise that because "every spine problem is different, every surgeon is different, every medical facility is different, every surgical procedure is different" it makes it impossible to have reliable statistics regarding spine surgery. Of course, what you stated is true but the same can be said of many other surgical procedures and this veil of confusion seems to exist particularly with lumbar spine interventions. I am not looking for an answer for me in the research....I am wanting to know what evidence exists that a fusion (again statistics are this to be considered when making a decision about treatment) vs. decompression without fusion has a likely better outcome over time in the aggregate.. I think how many people (again in aggregate) have significant pain relief after lumbar spine surgery, etc. how many require subsequent surgeries? When i really pressed my PCP about about many of her patients had adequate relief after lumbar spine surgery she said 50%. Good information although not exactly across population. I did have the MILD procedure (the only research was funded by VERTOS) .The doctor that recommended it said ALL his patients saw improvement because he picked so carefully. He was a at University of Pennsylvania and I had a really good feeling about him. I had no relief and when I wanted a follow up appointment I was told he only had appointments for NEW patients so that might have been why he was so gung ho about this procedure. It would have been nice to have independent research regarding this procedure, as well.
I have consulted numerous physicians, all reputable, all at teaching hospitals and have been told very different things. I liked them and trusted them but how do I choose?

The best across population research I can find is from countries where there is not a profit motive for these very very lucrative procedures. This link is to Swiss research. I think there can be more of this to help us decide. https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2794636

@kdks99 If I may, I would like to mention a book that I bought when I was contemplating spine surgery. It was written by a spine surgeon, David Handscom MD, who after doing surgeries for many years became a spine surgery patient himself. He has a lot of discussion about if back spine surgeries are necessary and decision making. He has a interesting perspective and he discusses the success rates as well as other nonsurgical ways to help patients. You can find his information at https://backincontrol.com/ .

Forgive me, @kdks99 , I communicate with many members and didn't remember about your MILD procedure until you mentioned it here. I'm sorry it didn't help. When comparing a fusion where a disc is removed with a procedure where the disc remains, and the extruded disc parts are removed or a decompression that allows the disc to remain, you have to ask what condition is the disc in? Will the disc herniate again and recreate the same problems? What changes happen as a disc collapses further?

Is the disc weakened enough to allow the vertebrae to slip past each other and by how much? If this is happening, is it stable enough as is? Is there spinal canal stenosis is addition to vertebrae that slip past it, and how much does that close down the spinal canal? What are the other reasons for spinal canal narrowing such as an enlarged ligament? Are the vertebrae also twisting in addition to slipping and how does this affect the rest of the spine? Is the spine beginning to fuse itself? How will aging affect my spine given my current status?

I never wanted to be a spine surgery patient, but it became obvious to me from my symptoms that I was on a track toward disability and I knew I had a chance to change that outcome with a cervical surgery. My doctors also told me that lumbar surgeries do not have the same success rates as cervical surgeries. I need to understand this in 3 dimensions similar to when a doctor explains by showing you a model. I am a patient who wants the details, the why does it happen? How much will happen? and how fast will it change if I do nothing? How much can I improve my condition with core strength exercises? How much will other health conditions affect my spine health? If I want to explore surgical options, how many choices do I have and what is the benefit vs risk for each taking into consideration the specifics of my health?

What other questions could patients ask their doctors to guide their discussions that could aid patients in decision making?

Jennifer