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Can you help me understand something? I had a spinal fusion surgery for degenerative disc disease six months ago. The surgeon gave me a thumbs up based on some test scores that showed improvement for me. Maybe I'm being a spoiled person but I'm actually disappointed in the results. Maybe I should have stuck with giving it some more time and trying other nonsurgical methods of treatment. What would you have advised?
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You didn't mention why you aren't happy with the results or what tests the surgeon used to measure "success." Some studies do have ways of determining the minimum amount of change in test scores that are considered significant (and therefore a sign of "success"). You may find some help from a recently reported systematic review comparing the results of fusion surgery with results for nonoperative care for this condition known as degenerative disc disease.
They used careful selection criteria to get the best evidence possible. Studies included had to use validated patient assessment tools to measure outcomes (e.g., the Oswestry Disability Index, Short Form Health Survey). Perhaps you completed one of these two patient self-report tools. Patient satisfaction and X-ray results were also acceptable measures of clinical outcomes.
Articles considered unacceptable for review (inclusion) and therefore excluded were: 1) based on opinion, 2) only reporting on surgical technique, or 3) included patients receiving a fusion at more than two spinal levels. In addition, studies that were too small (less than 20 patients) or too short (follow-up was less than one year) were not included.
Twenty-six (26) studies with a total of over 3,000 patients met the necessary standards to be included. All patients had pain and loss of function as a result of degenerative disc disease in the lumbar spine (low back). Spinal surgery done was fusion at one or two levels.
Specific information used to compare results included length of follow-up time, patient age, baseline back pain information, change in outcome scores, fusion rates, reoperation rates, and level of patient satisfaction.
Pain relief and improved function were reported for the fusion patients in the majority of cases. Overall patient satisfaction was 75 per cent for patients who had the fusion procedure, while patients in the nonoperative group reported a much lower rate (55.6 per cent) of satisfaction. The percentage of patients who had a successful fusion was 84 per cent. Seven per cent (7%) of the total group had a second surgery due to a failed first surgery.
Patients evaluating results of surgery versus nonoperative care for degenerative disc disease should keep in mind that these two treatments are not really competing with one another. Patients aren't usually given the opportunity to choose between them.
Instead, treatment is offered in a series: first conservative care with medications, physical therapy, and rest. Then, if the treatment fails, follow-up surgery (spinal fusion) is advised. Surgeons who seek the best evidence available to support their clinical decisions may rely on systematic reviews like this one to direct and guide them.
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