Spinal fusion operations may be needlessly crippling patients: expert

SURGEONS are being warned to stop routinely undertaking spine-fusing operations over fears too many patients are being left needlessly crippled.

The expensive procedure can have “terrible outcomes”. Picture: file

SURGEONS are being warned to stop routinely undertaking spine fusing operations over fears too many patients are being left needlessly crippled.

A gathering of Australian pain specialists will this weekend be told to scale back their reliance on common lumber fusion operations by visiting US expert Dr Gary Franklin.

It comes as the appropriateness of all spinal surgeries are being reviewed for and clinical relevance by the spinal surgery clinical committee as part of the Medicare Benefits Schedule Review Taskforce.

In the past five years Australian surgeons have performed more than 34,000 stand procedures to fire two or more vertebrae together to prevent any movement between them, a well as thousands of other fusions as part of other spinal operations.

While the operation was designed as a last resort for patients with significant measurable instability in their spinal bones, Dr Franklin will tell The annual gathering of the Faculty of Pain Medicine that most disc-related cases now undertaken in Australia and the US could be better treated with less invasive measures.

“I cannot think of another surgical procedure that has such terrible outcomes,” Dr Franklin said.

“A lot of people have back pain and we just need to learn to use (other) methods of treating it.”

Dr Franklin will present his findings at this weekend’s Adelaide, calling for government oversight and review of the appropriateness of lumber fusions.

A study of NSW workers’ compensation patients in the Medical Journal of Australia this year found the outcomes of spinal fusions were so poor the surgery was no longer recommended.

Dr Franklin - a neurologist and medical director of the Washington State Department of Labor and Industries - said his US study also found 44 per cent of workers were left permanently disabled a decade after fusion surgery.

While approved medications are constantly scrutinised, Dr Franklin said there was no oversight or regulation for surgical procedures, and nobody collecting data to determine if spinal fusions were curing or crippling the majority of patients.

“We are spending $100,000 or $50,000 for these procedures - invest $10 to retain and collect the data. It’s not rocket science, but we have clearly let this fall through the cracks and our patients and public budget is suffering for it,” he said.

However spine specialist and Royal Australasian College of Surgeons fellow Assoc Prof Richard Williams said fusions were used more conservatively in Australia than the US, with the radical surgery only considered after a year of observation and other failed alternatives.

While it was becoming increasingly apparent workers with active workers compensation claims were not well suited to the surgery, Assoc Prof Williams said annual figures showed it was increasingly being used only for those with the most necessary need.

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