Prolotherapy and Lumbar Spinal Fusion
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Prolotherapy and Lumbar Spinal Fusion
Ross Hauser, M.D.
Despite new implant technologies and surgical techniques leading to increased rates of spinal fusion surgery, the percentage of patients requiring further low-back surgery after spinal fusion has actually increased since the early 1990's, reports the September 1, 2007 issue of the journal Spine, published by Lippincott, Williams & Wilkins.
The study was done at the University of Washington in Seattle. They looked at rates of spinal fusion and repeated low-back surgery during two periods: 1990-93 and 1997-2000. During the 1990's, the percentage of patients undergoing spinal fusion more than doubled: from about nine percent during 1990-93 to 19 percent during 1997-2000. As the rate of spinal fusion surgery increased, so did the proportion of patients who later required another low-back operation. The risk of repeated low-back surgery after spinal fusion increased by about 16% from the beginning to the end of the decade.
Take home point: just because spinal operation technologies increase, doesn't mean the operations are better for you! Almost every spinal fusion operation patient I see tells me the same thing, "My pain is as bad or worse than before the operation. I wish I never had the operation." Most say that after the operation they were "better" for a time, but then the pain came back as worse than ever. They also say that their pain "moved" and is now in a different location.
Spinal fusion is an operation done to fuse together adjacent vertebrae in patients with certain types of chronic low back pain. In the 1990's, the U.S. Food and Drug Administration approved "cage" devices which could be used for fusions instead of bone. The number of operations increased dramatically, but in the end, all that happened was more patients needed additional surgeries. The conclusions of the authors in the Spine journal article were "A higher proportion of fusion procedures and the introduction of new spinal implants between 1993 and 1997 did not reduce reoperation rates."
Common sense would tell anyone that when you fuse two or three spinal segments together, that spinal movement has to come from somewhere. Where? The spinal segments above it and below it will have to move "excessively" because of the spinal fusion. Ultimately, this extra movement and strain will cause accelerated degeneration of the disk, ligaments, and joints of these segments, thus making the person more prone to pain in these areas. This is most likely the explanation for the increased pain a few years down the road and the "need" for more operations later. Is there a better way?
I believe the best alternative to spinal fusion operation is Prolotherapy. Prolotherapy can help stabilize the areas that are painful without causing a "complete" fusion. What the spinal segments need that are weakened, loose, or painful, is stabilization, not fusion. They just need to be stronger. One way to get them stronger is to receive Prolotherapy injections into and around the vertebral facet joints and transverse processes to stimulate repair. Once these vertebral segments are strong, the pain starts to go away. One of the best alternatives to help a person reduce their low back or neck pain without a spinal fusion is Prolotherapy. For most cases three to eight visits of Prolotherapy, given once per month is all that is needed. Remember getting one spinal fusion operation may end up leading to another. Perhaps, a second opinion by a Prolotherapy doctor before getting a spinal fusion operation is needed? It may just help you not need surgery.
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