Spinal fusion has become a heated topic in orthopedic care today. Why so controversial? Recently, a major article named spinal fusion on a list of four surgeries to avoid. The reasons given to avoid this surgery included complications, other post-surgical health issues, the high reimbursement potential for doctors, low success rates and less invasive alternatives.
For some patients, after exhausting all other options, spinal fusion is their only course of treatment. And for patients considering traveling for spinal fusion, it’s important to debunk some of the negative information circulating about this touchy topic.
Reasons for Spinal Fusion
Spinal fusion is a procedure used to treat different spine conditions. This includes spinal stenosis, whereby a narrowing of the spinal canal puts pressure on the spinal cord and nerves in the spine. Another condition that may need spinal fusion is spondylolisthesis, which is a condition where a vertebra slips on to the vertebra below it.
Other reasons in which patients may need spinal fusion surgery include spinal injury and tumors. Additional reasons for spinal fusion are previous failed surgeries or a weak and unstable spine.
Most patients recommended for spinal fusions have had years of documented back pain, injury, or diagnosed conditions. At the point where spinal fusion is brought up with a physician, the patient likely has a lot of pain, immobility, or a decreased quality of life. Other treatment options have already been tried, and were not fully effective.
Spinal Fusion Explained
In this current age of minimally invasive spine surgery, spinal fusion is an invasive procedure. It is more of a major surgery, which can make some patients wary of having it or traveling to have it.
Spinal fusion is usually done in the lumbar spine, or lower back. The procedure involves permanently bringing together two or more bones (vertebrae) in the spine so that there is no movement between them. Physicians use a graft, often a bone graft, to fuse the vertebrae together. There are different ways-
Most patients recommended for spinal fusions have had years of documented back pain, injury, or diagnosed conditions.
There are different ways of fusing vertebrae over part of the spine or between vertebrae. Some procedures use rods, screws, plates, or cages to fuse the vertebrae, which keep them from moving until the grafts are healed.
Lumbar spinal fusion surgery is designed to create solid bone between adjoining vertebrae, eliminating any movement between the bones. The goal of the surgery is to reduce pain and nerve irritation.
Increase in Spinal Fusion
A study found that from 1998-2008, spinal fusion increased by 137 percent. Many in the health community worldwide are concerned that this increase is too high. Due to financial incentives for physicians, they warn that the procedure is being performed too much.
However, this statistic probably does not take into account that back surgery has become safer in general, as more innovations are made in spine care. From a physician’s perspective, there are times when spinal fusion needs to be performed. However, the decision to go ahead with spinal fusion should only be done after carefully reviewing all options with the patient.
Policy Statement from International Advancement for Spine Surgery
The International Advancement for Spine Surgery (ISASS), an organization dedicated to discussing and assessing strategies and innovations in spine care to provide patients optimal care, addressed the increase in spinal fusion in a policy statement.
The statement only concerns traditional lumbar spinal fusion, not using newer medical devices. ISASS made clear distinctions about when spinal fusion is an appropriate course of treatment, and when it is not recommended.
Patients who have spent years experimenting with other treatment options stand to gain great relief and an improved quality of life from spinal fusion.
According to ISASS, spinal fusion is appropriate with the following diagnoses and conditions: emergency situations, trauma, and revisions for prior failed surgery, tumor, infection, flat-back syndrome, pseudoarthrosis, adjacent segment degeneration, deformity, spondylolisthesis, spondylolysis, recurrent disc herniation, stenosis with instability documented pre-operatively, and degenerative disc disease.
Overall, ISASS strives to show that spinal fusion is an effective procedure, but should only be performed when deemed medically necessary due to the diagnosis.
The ISASS statement continued to say that spinal fusion can be considered on a case-by-case basis for the following situations: rare and unusual cases, degenerative disc disease in the elderly or at multiple levels, and facet syndrome.
But, spinal fusion is not appropriate in cases of only stenosis (without any of the other diagnoses previously mentioned), initial disc herniation (in the absence of any other diagnosis noted above) and chronic lower back pain without a clear cause evident in imaging.
Minimally Invasive Spinal Fusion
There are minimally invasive spinal fusions available, but they are only right for certain patients. However, patients can ask their physician and see if these methods are offered, and if they are a potential course of treatment. It all depends on the patient’s individual condition.
Minimally invasive spinal fusion procedures include the eXtreme Lateral Interbody Fusion (XLIF®), Instrumented Lumbar Interspinous Fusion (ILIF®), and Aspen® MIS fusion system.
XLIF procedure removes a damaged disc and replaces it. XLIF surgery is done by making a small incision in the patient’s side, which means less disruption of muscles, bones, and ligaments. In effect, patients have a quicker recovery.
Physicians use computer technology to remove the damaged disc and replace it with a small cage containing a protein that grows new bone.
ILIF procedure treats lumbar spinal stenosis treatments using a minimally invasive surgical technique. ILIF procedure involves a laminotomy, which opens up the space between the vertebrae. The surgeon carefully removes only small sections of bone to release the pressure on the spinal cord and nerves.
Aspen is a type of artificial insert used in a minimally invasive spinal fusion surgery. This is an alternative to titanium rods or screws. The goal of using the Aspen surgical system implant is to stabilize the spine. Some benefits of the Aspen surgical system include secure fixation in the spine, integrated bone graft enclosure, and cutting-edge design. The Aspen procedure is usually used to treat degenerative disc disease, spondylolisthesis, or trauma.
Less Invasive Options: Not Always an Option
Less invasive solutions should always be the first line of treatment for back pain and conditions, such as arthritis, spinal stenosis, spinal fusion, and weakened spine.
According to Milliman Care Guidelines (MCG), spinal fusion is an appropriate treatment when other treatments have been tried and failed, and/or when decompressing the spinal cord makes the spine unstable to the point where fusion is necessary for stability.
MCG is a developer and producer of globally sourced, clinically validated best practices for health systems.
For some patients, these newer, minimally invasive spinal fusion techniques will work instead of traditional spinal fusion. Depending on the patient’s condition and prognosis, these options may reduce the recovery time and possibly prevent a hospital stay.
Of course, the best treatment option needs to be determined by a physician. But, some patients have already tried less invasive treatments, or have instability in their spine to the point that traditional spinal fusion is appropriate.
If a patient’s symptoms are persistent and disabling, his or her diagnosis is confirmed by imaging, such as an MRI, and three months of physical therapy, injections or other treatments have not worked, then spinal fusion is a definite possibility.
Traveling for Spinal Fusion
Spinal fusion can be an expensive surgery. In fact, high physician reimbursements in the United States were one reason given to avoid spinal fusion. However, most physicians would only recommend spinal fusion when it’s absolutely needed, such as when other treatment options have failed, as outlined by ISASS and MCG.
If a patient is uninsured or under-insured, then traveling for spinal fusion can open up a new world of opportunity.
Spinal fusion is a specialized procedure, and thus domestic or international medical tourism may be options for patients who want to go through with spinal fusion.
Patients may choose to travel to the United States, India, Costa Rica, Thailand, Croatia, or another country for a spinal fusion procedure. There are many Joint Commission International-accredited facilities around the globe that perform spine surgery.
As with any surgery, there are risks. Spinal fusion can also be risky depending on the nature of the patient’s spine. If there is serious weakness or injury, there can be complications. This is why it’s important to choose a physician with experience in spinal fusion. Many techniques involve new medical devices, and patients should do their research.
Time Frame for Spinal Fusion
One important consideration when traveling for spinal fusion is giving enough time for initial recovery before flying and being stuck in a seat for a potentially long period of time.
About a week is the recommended amount of time between the surgery date and heading home. This allows time for initial pain level to decrease.
The recovery period for spinal fusion includes a few days inpatient, and physicians and staff will assess patients before they are discharged. Patients should be able to get up and walk around (as soon as the day after surgery), have pain under control, and empty their bladder on their own.
Spinal Fusion Recovery
It is important for patients not to overdo it. Though they may want to get out and explore a new country, they need to take it easy and avoid bending, twisting, and lifting heavy objects like a suitcase. Patients should avoid the hotel pool, hot tub, ocean, and/or any body of water until their incision is healed. Walking is definitely recommended, so patients are encouraged to walk around.
Spinal Fusion: Final Option
Many patients with back conditions suffer from debilitating pain that interferes with their daily life and activities. Prior surgery, physical therapy, pain injections, exercise – none of these treatments have worked thus far. In a case such as this, spinal fusion surgery can be a final option to treat their pain.
While it is great for patients to educate themselves on surgery, the goal is not for them to be afraid of certain procedures, especially if they have already tried conservative treatments. Patients who have spent years experimenting with other treatment options stand to gain great relief and an improved quality of life from spinal fusion.
Final Tips for Patients Traveling for Spinal Fusion Some final tips for patients considering traveling for spinal fusion:
Do research – Be sure to find a physician experienced in spine surgery, and specifically spinal fusion. The American Medical Association recommends checking the Joint Commission International or International Society for Quality in Health Care for qualified physicians.
Preparation – Bring along lab results, medical imaging such as MRIs, and anything else relevant. Bring a list of your allergies and any medications currently taken.
Get everything in writing – The Centers for Disease Control (CDC) recommends having a written agreement with the healthcare facility abroad, clearly stating what is covered by the cost of the trip.
Vacation mindset – Keep in mind, this is not exactly a holiday. Make sure to understand limitations on activity following surgery, and plan activities accordingly.
Continuing care – Set up appointments with a primary care physician or specialist for follow-up care upon returning home. It’s important to do this to ensure the incision is healing and progress is being made.
Patients need not be afraid to travel for spine surgery. There have been great advances in spine care in recent years and being uninsured or under-insured should not stop patients from getting their mobility and quality of life back again.
About the Author
Amanda Dickson is a full-time writer and editor for Advanced Healthcare Partners (AHP), a leading healthcare management and consulting company focused on increasing revenues through a strategic approach to sales, marketing, and financial strategies for high potential, forward thinking healthcare practices, platforms, and concepts. In 2013, AHP was a finalist in the Greater Tampa Chamber of Commerce’s Small Business of the Year in the start-up category.
