If you and the team of medical professionals you work with are following clinical guidelines, you’re only considering spinal fusion surgery as a last resort. That means that you think the cost, recovery time and risks associated with the procedure are unavoidable if you want to regain a normal life.
However, some patients may still have options. There is a minimally-invasive form of the procedure that may yield the same benefits as open surgery with less cost, recovery time and risk. This minimally-invasive approach has not been extensively studied, however. That’s why a recent study into quality of life measures in 304 patients who received the more conservative procedure is important.
Patient progress was retrospectively tracked for between two and seven years post-surgery. The average mental and physical health scores increased from 43.8 to 49.7 and 30.6 to 39.6 (on a 100-point scale) respectively. Disability scores dropped from 43.1 to 28.2, and pain scores dropped from 7 to 3.5 (on a 10-point scale).
This suggests that minimally-invasive spinal fusion may be an effective back pain treatment component for people in need of surgery. However, it doesn’t, in itself, recommend the practice over open surgery.
The researchers involved in this study took careful note of its limitations, one of the most obvious being its lack of a comparison open fusion group. What if the outcomes of open fusion are significantly greater?
The researchers did situate the results of their study within the context of other studies, some of which did feature a comparison group. They cite several studies that concluded less blood loss, lower cost and shorter hospital stays in favor of minimally-invasive fusion. They also note that one study found open fusion’s improvement of disability scores at one and two years post-surgery to be inferior to the improvements noted in the current study (22.9% and 22.8% respectively in the open fusion study, compared to 31.3% and 29.9% in the minimally-invasive study).
This cannot be taken as proof that minimally-invasive fusion is superior due to the fact that these studies are disparate, but it can be taken to suggest that the two procedures may be at least comparable in effectiveness.
Minimally-invasive fusion comes with many of the same risks as regular fusion: hardware breakage, malpositioning or migration; internal bleeding; failure to fuse; wound infection; deep vein thrombosis; adjacent segment degeneration and others. In all, 3.9% of patients in the study required reoperation. This is lower than the rate for open fusion reported by many studies.
Researchers noted that the rate of successful fusion was abnormally high in their study – over 95%, far exceeding open fusion rates. They suggest that their minimally-invasive method, which, among other things, leaves the paraspinal muscles intact, was responsible for this.
See more on this study at www.medscape.com.
Patients should take heart that a referral to the surgeon doesn’t necessarily mean open spinal fusion. There are alternative surgical procedures, including minimally-invasive fusion, disc replacement and more that you can ask the surgeon about. It’s also a good idea to get a second and even third opinion.