An editorial by Peul in the New England Journal of Medicine got me thinking about the number of (un)necessary spinal fusions that are done in this country every year. There are certainly reasons for fusion especially in the presence of true spinal instability, severe scoliosis deformity or neurological compromise, but how often are fusions done in those without true instability? I suspect, though have not seen the data, that often decompression alone may have been justified over fusion due to the lack of true instability which is observed via flexion-extension x-rays. The editorial reported on several other studies to make their assertions against fusion and cite higher costs, rates of infection and re-operation rates as part of the decision making process. The other piece of the puzzle is what does the fusion surgery add to functional outcomes vs. decompression only…study findings suggest nothing. If this is true, then why should fusions continue to be so regularly done???

If considering spinal surgery, make sure to truly exhaust all possible conservative options (PHYSICAL THERAPY, injections, etc) and put forth max effort to avoid such invasive procedures. Just going through the motion to satisfy insurance requirements prior to imaging, injections or surgery is more likely to lead to poorer outcomes in the end.