Efficacy of Spinal Fusion?

(From the March 2007 The “G”Note)

The number of spinal fusions has escalated over the years. Medicare and most workers’ compensation plans reimburse for spinal fusion. Medical journals have begun to raise questions about the procedure. Two articles in the January 2007 issue of The Backletter discuss the efficacy of spinal fusions. In this era of evidence-based medicine, the evidence for spinal fusion in discogenic pain is poor. Short-term and long-term benefits of spinal fusion over non-surgical treatments are lacking, particularly for patients over age 65 years. In the elderly, there is a 1% to 1.6% mortality rate. In Washington State, a 1994 study of workers who had spinal fusion found that 68% had poor outcomes. In spite of this study, the number of injured workers in the Washington State workers’ compensation system who had spinal fusion continued growing rapidly. (Franklin, et al 1994, The Backletter 2007) Franklin, et al. also found a clustering of lumbar fusion among a small number of surgeons and hospitals. (Franklin, et al 1994) Morerecent studies in 2003 (Brox, et al), 2005 (Fairbanks, et al), and 2006 (Brox, et al), also found that spinal fusion was no more effective than structured rehabilitation programs. New technologies, such as, fusion cages and instrumentation (e.g., pedical screws), have not lead to better outcomes.

In spite of the poor evidence of the benefits of spinal fusion presented in a 2006 conference, in late 2006, the Centers for Medicare and Medicaid Services (CMS) decided to continue coverage of spinal fusion.

References:

Medicare and Spinal Fusion. The Backletter January 2007; 22(1):3.

Warnings on Spinal Fusion for Patients on Workers’ Compensation Fell on Deaf Ears. The Backletter January 2007; 22(1):4-5.

Franklin GM, Haug J, Heyer NJ, et al. Outcome of Lumbar Fusion in Washington State Workers’ Compensation. Spine 1 September 1994; 19(17):1897-1903.