Spinal fusion for sciatica is the most drastic and damaging surgical treatment option possible for patients whose pain has not responded to a host of more conservative therapy options. Spinal fusion surgery is one of the time honored mainstays of the back pain industry, but remains a hotly controversial procedure to this day.
This discussion will detail why fusion is such a poor option for almost every cause of sciatica. We will examine the many risk factors associated with fusion and provide some lesser known facts that every patient considering the technique must understand before going through with the procedure.
Fusion surgery entails joining problematic vertebral levels together to eliminate their ability to move as individual bones. Two or more vertebrae can be joined in the hope of eliminating symptoms which are produced from movement of those vertebral levels against one another.
In essence, what you have in a spinal fusion procedure is the joining of 2 or more spinal bones, which previously moved individually, to become one solid piece of bone, which moves as a single unit unto itself. Of course, this fusion goes against the natural design of the human spine and will cause several known problems which are well detailed below.
Fusion is an extremely invasive surgical technique which does considerable damage to healthy spinal tissues and muscles.
The doctor will create one large or several smaller incisions and typically perform a full discectomy on the affected vertebral levels. This means that the old disc material, which provided spinal flexibility, is removed completely.
Once the discs are gone, the doctor will install bone grafts, which can be acquired by harvesting the patients own tissue, using live or cadaver donor tissue or can be synthesized using artificial bone substitute. These grafts are placed around the vertebral levels to be joined and will eventually grow into a solid block of fully formed bone, if all goes well.
Often, surgical fusion hardware is also installed. These scary looking devices consist of cages, screws, pins, plates and other assorted hardware, which truly resemble medieval torture equipment. Sometimes this hardware is installed temporarily and removed once the bone grafts are solidified. Other times, the hardware becomes a permanent part of the fusion.
I am an admittedly fierce critic of spinal fusion surgery. The entire concept of the operation goes against the natural form and function of the spine. This is a very unenlightened approach to back health and is the most problematic of all sciatica surgeries.
Fusion has numerous inherent risks and many patients never recover from this barbaric operation. Many fusions do not hold properly and must be re-operated. Fusions which do hold properly will still drastically limit spinal functionality.
Fusions can be re-injured at any time in the future and often create limitations on physical activity for life.
Many patients suffer hardware-related pain, or malfunctions, and require revisions at some point in the future.
Worst of all, spinal fusion places increased pressure on surrounding vertebral levels, exponentially increasing and escalating the natural degenerative processes to an often symptomatic level. Over time, these vertebral levels can become unstable, requiring the addition of more and more solidified levels to the fusion. Many patients wind up with multiple fusions over the course of 10 or 20 years, until they have basically no normal spinal function left at all.
However, using fusion to treat virtually any disc condition or osteoarthritic condition is madness. Ironically, these are the conditions most often treated using this ridiculous notion.
To summarize, I offer you this: Of all the letters and emails I receive each week, there are always several from patients who have endured one or more spinal fusions. Generally, these poor people are completely disabled, in horrific pain and extremely unhappy about their decisions to have the operation. Most say they really had no idea what life would be like after the fusion or they never would have done it.
This is precisely why it is so crucial to take an active role in your own healthcare and sciatica treatment. Do not allow your lack of knowledge over the risks of a proposed therapy threaten your very life.
I have met some patients who have enjoyed successful spinal fusion for sciatica, helping their pain and even allowing them a basically unrestricted lifestyle. However, these circumstances are certainly in the minority of cases, at least in my own experience dealing with tens of thousands of patients every year.