Spinal Fusion for Chronic Low Back Pain: A ‘Magic Bullet’ or Wishful Thinking?
- Author:
Dhillon KS
- Publication Type:Case Reports
- Keywords:
Chronic low back pain;
spinal fusion
- MeSH:
Low Back Pain
- From:Malaysian Orthopaedic Journal
2016;10(1):61-68
- CountryMalaysia
- Language:English
-
Abstract:
Chronic low back pain is a common, disabling and costly
health problem. The treatment of chronic low back is
difficult and is often ineffective. For treatment to be effective
the cause of the pain has to be established but unfortunately
in 80% to 95% of the patients the cause cannot be
determined despite the existence of modern imaging
techniques. A pathoanatomical diagnosis which fits into a
classical disease model where successful treatment can be
carried out, can only be made in 5% to 7% of the patients.
The back pain in the rest of the patients where no
pathoanatomical diagnosis can be made is often labelled,
unscientifically, as chronic low back pain. Despite the
existence of sophisticated imaging techniques and a plethora
of diagnostic test the source of pain in patients with nonspecific
back pain cannot be established. There exist no
causal relationship between imaging findings of degenerated
disc, lumbar facet arthritis, spondylosis, spondylolysis and
spondylolisthesis, to the pain in these patients. Surgical
treatment of non-specific back pain where no
pathoanatomical diagnosis has been established is bound to
fail. Therefore the outcome of spinal fusion in these patients
can be no better than nonsurgical treatment. Spinal fusion is
a major surgery which can be associated with significant
morbidity and occasionally with mortality. Yet there is rapid
rise in the rates of spinal fusion. There is a growing tension
between ethics and conflicts of interest for surgeons. The
spine, unfortunately, has been labelled as a profit centre and
there are allegations of conflicts of interest in the relationship
of doctors with the multi-billion dollar spinal devices
industry. The devices industry has a significant influence on
not only research publications in peer review journals but
also on decisions made by doctors which can have a
detrimental effect on the welfare of the patient.
- Full text:P020160713367030627731.pdf
