Spinal Surgeries Questioned.
SPINAL fusion surgeries for chronic low back pain are on the rise, despite the lack of research to back their efficacy, and experts are now calling for tighter guidelines, including a waiting period.
Dr Richard Williams, orthopaedic surgeon and spokesperson for the Royal Australasian College of Surgeons, told MJA InSight that a key regulation should be that patients must wait a period of 12 months before a spinal fusion surgery was performed.
During this time, the patient must undergo aggressive rehabilitation to try to lose weight and reduce their back pain.
"Most patients will recover after these 12 months,” he said. "It's also the duty of the doctor to set realistic expectations for the patient, and explain that spinal fusion rarely results in having no pain at all. The surgery works for a proportion of patients, not all."
Dr Williams was commenting on an article published online by the MJA which discussed the controversy around spinal surgery for chronic low back pain. The authors wrote that there was a continued lack of evidence when it came to the benefit of spinal fusion for low back pain.
In 1999, a Cochrane review found there were no published randomised controlled trials which established effectiveness of fusions for chronic pain. A 2005 review was critical of the outcomes measured, saying that the limited evidence on the long-term effects of either surgical decompression or fusion remained a matter of concern, given the numbers and the costs of the surgical procedures being performed.
The authors wrote that patients were presenting with high expectations of modern medicine, and in many cases there were additional entitlements to monetary gains from workplace injury compensation and third-party incidents.
“There has been a lack of patient-oriented surgical outcomes, and there is a lack of outcomes for most things that we do for chronic low back pain,” they wrote.
While the spinal fusion procedure remains controversial, it would be valuable for spinal surgeons to undertake a national audit of patient-centred outcomes for the procedure, the authors concluded... (Please go to the above link for the rest of the article.)https://www.mja.com.au/insight/2016/15/spinal-fusion-surgeries-questioned