Spine fusions by segment, 2008 & 2017

Spinal fusion is still considered the gold standard for treatment of LBP due to DDD, but it may not hold that title for much longer. Holding spinal fusion as the optimal treatment was based on the assumption that a degenerated spinal segment is either unstable or moves outside of the normal range of motion. Both of these have been associated with the generation of pain, and therefore the stability offered by fusion would decrease or eliminate the source of the pain.

Recent studies, however, have shown that spinal fusion can result in a high rate of complications, increased morbidity, relatively high rate of re-operation, and no guarantee of satisfactory decrease in the patient’s post-op pain. Some surgeons and industry experts have opined that spinal fusion is overused in the US. In addition, fusion eliminates motion in the fused segment and puts additional stresses on the adjacent segments, causing what is known as ‘transition syndrome.’ These potential complications point to one reason why attention has focused on recent years on dynamic stabilization: stopping the motion of the affected segments is not succeeding very well, so perhaps stopping all motion is not the most important factor in the equation.

Source: MedMarket Diligence Report #M510, "Spine Surgery Worldwide."

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