Spinal fusion is the extreme operation for back pain. Its aim is to lock a part of the spine and may be recommended for debilitating scoliosis, spine fractures or type IV of spondylolisthesis. But these reasons are rarely the motivations for the spine fusion.
It is largely considered and presumed that the degeneration of the disk and osteoarthritis, creating instability and inflammation, are the obvious cause of the low back pain, most of the time at the level of the the lombo-sacral junction. In this regard, the surgeon will remove the deteriorated disk between the vertebrae and stick the bones together. The purpose is to stabilise the hyper-mobile spine area and then the pain will logically disappear.
However, as we have seen in a previous blog, a majority of people in their middle age have degenerated disks and mostly free of pain. Reversely, a majority undergoing a spine fusion in the regard of a dehydrated disk resent more pain after the operation!
According to a study carried out at Oregon Health and Science University, half of the patients undergoing a spine fusion used opioids prior to be operated and only 9% ceased afterwards. Ironically, 13% used them after the operation while they did not before. Another study showed that hardly half of the patients after surgery reported a decrease of 30% of the pain and a third of improvement in function. In spite of this, the spine fusion remains very popular.
The problem is that if one part of the spine is fused and rigid, the forces applied to the lumbar spine during daily tasks are directed to other segments above or below this part, and this will lead to early degeneration of the other disks and create some osteoarthritis.
Instead of a spine fusion, it is largely admitted that an advanced rehabilitation is more appropriated, accompanied with behavioural therapy to reconsider low back movements.