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Doc recommends spinal fusion from T12 - S1.
Spine Health | Last Active: 1 day ago | Replies (110)Comment receiving replies
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
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@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