In October 2013, the Washington Post wrote a scathing article on spinal fusion surgeries being performed in Florida (and throughout the US). In part, they found that more than 50% of the 465,000 fusions performed in 2011 did have have adequate documentation to necessitate the surgery.
Over the past 20 years the rate of spinal fusion surgery has increased six fold. Yet, nearly all long term outcome assessments show we are not adequately treating spine related complaints.
In the past, extensive and expensive lobbying efforts have succeeded in suppressing the advancement of clinical guidelines. At this time, there are no accepted models of when a spinal fusion is truly necessary. The Post found, "...at a broader level, the rapid rise of spinal fusions in the United States, especially for diagnoses that generally don't require the procedure, has raised questions from experts about whether, amid medical uncertainty, the financial rewards are spurring the boom.".
At the very least, barring an emergency/red flag presentation, patients should be encouraged to explore ALL conservative options available to them prior to entertaining the idea of fusion surgery. Research continues to show chiropractic as the best first line treatment option. If unsuccessful, then physical therapy, medication, and/or injections may be considered. This article does not even begin to touch on the adjacent segment disease which affects the vertebral segments surrounding the surgical fusion site.
With significant complication rates, sky high prices, and potentially un-ethical decision making from the physicians and hospital systems; it is more imperative than ever to promote the safety and efficacy of conservative care.
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