Blog article
Reevaluating spinal fusion as a back pain solution
While spinal fusion surgery is often recommended for specific spinal conditions, growing evidence highlights its limitations and risks.
In this blog, we delve into why spinal fusion may not always be the best solution, explore its potential drawbacks, and discuss alternative approaches to managing back pain effectively.
Understanding back pain
Due to the spine's structural complexity – comprising vertebrae (individual back bones), discs made of cartilage, muscles, ligaments, tendons, and the spinal cord with nerves exiting the spine – pinpointing the exact cause of back pain can be tricky, even for doctors and specialist allied health professionals (like physiotherapists and exercise physiologists) with access to imaging tools like ultrasounds and MRIs.
When it comes to treatment for back pain, options range from strengthening and rehabilitation exercises to pain medication and surgery. One type of surgery that’s been hotly debated in recent years is lumbar spinal fusion surgery – once considered a breakthrough in treating debilitating back pain, there’s growing evidence that it may not be the best solution for all patients.
What is lumbar spinal fusion surgery?
Lumbar spinal fusion surgery involves permanently joining two or more vertebrae in the lower back to stabilise the spine, improve functionality, and (hopefully) reduce pain. Surgeons use bone grafts, metal implants, or both to help the vertebrae grow together over time.
Lumbar spinal fusion surgery is usually recommended once all other avenues have been exhausted – like physiotherapy, medications, and injections – but the pain still won’t go away. Spinal fusion is also often used for conditions like degenerative disc disease, spinal stenosis (a narrowing of the spine), or spondylolisthesis (when vertebrae slip out of place).
Lumbar spinal fusion surgeries in Australia
Over the last few decades, spinal fusion surgeries have increased significantly, with a growing number performed worldwide. In Australia alone, over 14,600 hospitalisations between 2015 and 2018 were for lumbar spinal fusion surgeries, with the private sector performing the vast majority at 83%.2
This rise can be attributed to several factors, including advancements in surgical techniques, greater distribution of spinal instrumentation, and an aging population who are generally more susceptible to spinal disorders.
How effective is lumbar spinal fusion surgery?
Here’s where things get tricky. Despite its widespread adoption, the effectiveness of lumbar spinal fusion surgery for management of chronic low back pain has been called repeatedly into question3,4,5. Comparative studies reveal that for many patients with common spinal conditions, lumbar spinal fusion surgery often provides no significantly better outcomes than non-surgical interventions3, raising concerns about whether its benefits justify the associated risks and costs.
Concerningly, revision surgeries – additional procedures required due to complications or incomplete pain relief – are relatively common. Some data suggests the revision rate could be as high as 45%,4 indicating that the initial lumbar spinal fusion surgery may not always deliver lasting benefits, leaving patients with ongoing discomfort.
Like any medical procedure, lumbar spinal fusion surgery is not without risk, with complication rates ranging from 9% to 17%.5 Potential complications include infection, nerve damage, blood clots, and failure of the fusion to heal properly, which can worsen a patient’s condition or require additional medical interventions.
How to manage back pain without surgery – and how HBF can help
Thankfully, there are plenty of other ways to manage back pain before resorting to surgery. Experts recommend trying:6
- Staying active: Prolonged rest can exacerbate back pain. Regular movement can help alleviate discomfort and improve sleep quality.
- Maintaining a healthy weight: Keeping your weight in check can ease the pressure on your spine.
- Quitting smoking: Smoking has been linked to a higher risk of back and neck pain as well as certain types of arthritis.
- Reducing stress: High stress levels can worsen pain by increasing muscle tension and spasms.
Healthcare guidelines stress the importance of discussing your options with your doctor to make sure surgery is the best option for you.
If you have eligible extras cover with HBF, you may be able to claim benefits for services that support managing back pain and improving your overall wellbeing, such as:
- Physiotherapy: A physio can assess your condition, provide targeted exercises to strengthen your back, and help you maintain mobility while reducing discomfort.
- Exercise physiology: Get expert guidance on physical activity tailored to your needs, focusing on improving your strength, flexibility, and overall fitness to support your spine.
- Remedial massage: Recover with massages designed to ease muscle tension, reduce spasms, and alleviate back pain.
- Psychology: A psychologist can help you develop strategies to manage stress effectively, promoting better mental and physical health.
- Nutrition and dietetics: A dietitian can provide advice on a balanced diet to support weight management and overall wellness.
If you’re an HBF member, you can check what you're covered for by logging on to myHBF or calling us on 133 423.
How to make an informed decision
As healthcare systems worldwide strive to deliver high-quality, cost-effective care, re-evaluating the role of spinal fusion surgery and promoting alternative approaches that prioritise conservative management and evidence-based practice are essential.
Thankfully, we can all be more ‘health literate’ than ever these days. We’re encouraged to ask questions, consult reliable sources of information and discuss any concerns with our healthcare providers so we can weigh up all our options.
Choosing Wisely, an initiative funded by the Australian Government Department of Health and Aged Care, is a great first port of call for more information to help you make informed decisions about your health care. When it comes to chronic low back pain (CLBP), Choosing Wisely recommends against performing lumbar spinal fusion surgery for localised, uncomplicated chronic lower back pain.
For more information, head to the Choosing Wisely website.
