back pain surgery

Doubts about spinal surgery

New research in the medical journal Spine suggests that patients who have a case review by a team of spinal pain specialists will likely not get a spinal fusion surgery.

In the study the researchers representing Virginia Mason Medical Center, Massachusetts General Hospital, and the  University of Washington implemented a multidisciplinary conference involving physiatrists, anesthesiologists, pain specialists, neurosurgeons, orthopaedic spine surgeons, physical therapists, and nursing staff.

Over ten months, they examined patients being considered for spinal fusion or who had a complex history of prior spinal surgery. They discussed the patients’ cases and when they decided on surgery and the type of surgery they chose to see if these were good recommendation.

This is what the research suggested:

“Isolated surgical decision making may result in suboptimal treatment recommendations. Multidisciplinary conferences can reduce the utilization of lumbar spinal fusion, possibly resulting in more appropriate use of surgical interventions with better candidate selection while providing patients with more diverse non-operative treatment options.”1

Another study cannot conclude if surgery for spinal stenosis is of any benefit

Doctors at the Italian Scientific Spine Institute published their research in December 2016 which gave this warning to patients considering surgery for spinal stenosis.

“We have very little confidence to conclude whether surgical treatment or a conservative approach is better for lumbar spinal stenosis, and we can provide no new recommendations to guide clinical practice.

However, it should be noted that the rate of side effects ranged from 10% to 24% in surgical cases, and no side effects were reported for any conservative treatment.

No clear benefits were observed with surgery versus non-surgical treatment.

These findings suggest that clinicians should be very careful in informing patients about possible treatment options, especially given that conservative treatment options have resulted in no reported side effects.”2


1 Yanamadala V, Kim Y, Buchlak QD, Wright AK, Babington J, Friedman A, Mecklenburg RS, Farrokhi F, Leveque JC, Sethi RK. Multidisciplinary Evaluation Leads to the Decreased Utilization of Lumbar Spine Fusion: An Observational Cohort Pilot Study. Spine (Phila Pa 1976). 2017 Jan 6. [Pubmed]

2 Zaina F, Tomkins-Lane C, Carragee E, Negrini S. Surgical versus non-surgical treatment for lumbar spinal stenosis. Cochrane Database Syst Rev. 2016 Jan 29;(1):CD010264. doi: 10.1002/14651858.CD010264.pub2. [Pubmed]

3. CMRS Lumbar Spinal Stenosis article