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Not All Spinal Fusions And Spinal Surgeons Are Created Equal

Authored by Dr. Christopher Good, MD, FACS. February 22, 2016


Part One: Many spinal conditions can be treated non-operatively.
Part Two: If spinal surgery is suggested, it doesn’t automatically require fusion.
Part Three: Spinal fusion may offer a better qualify of life, rather than adapting to the pain.

When it comes to spinal fusions, even for the same condition and for similar patients, it is critical to note that all spinal fusions are not created equal.

There are many ways to go about fusing a single level of the spine, mainly related to the direction that the surgeon uses to approach the spine and the amount of damage this may cause to the body on the way in.  In general, a surgeon can reach a person’s spine through the back (posterior), the front (anterior), the side (lateral), or some combination of these approaches {Figure 1}.  There are also many different types of implants and grafts used to achieve fusion and these can play a major role in determining success versus failure.

When performing surgery, our goal is get to the body part that is diseased while trying to avoid disrupting or damaging normal body tissues on the way in and the way out.  For example, surgery in the back portion of the spine carries a different level of pain and disruption of normal tissues than does surgery in the side or the front.  Ideally, the approach a surgeon uses to fix a problem should depend on the exact location of the problem for the patient, but in many cases, the approach a surgeon uses may be based simply on their education, preference, convenience, or comfort level.

When contemplating a spinal fusion, I believe it is critical to work with a surgeon who is comfortable with every approach and can factor in the benefits and risks of each approach when making a recommendation.  Surgeons who are not trained or do not commonly use each approach are very limited in what they can offer a patient.  I remember the old adage, “if the only tool in your toolbox is a hammer, everything looks like a nail”.  If a surgeon only does surgery through an incision in the back of the spine, then that is the only type of surgery they will recommend.

About The Author

Dr. Christopher Good, MD, FACS

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