To Cut or Not to Cut: Very Long Term Outcomes of Spinal Fusion Surgery

Over time, surgeons have moved to more and more complex procedures.  But whether these lumbar spine surgeries are better is still in question.

Initially, spinal surgeries were less complicated with procedures like laminotomies and laminectomy, but surgeons (at least under Medicare) have been moving towards more complex procedures that are more expensive with a higher rate of complications.  The problem with the vast majority of studies on the outcomes of surgery look at very short-term, usually no longer than 1 or 3 years.  The re-surgery rate is known to be as high as 23% after 10 years.

So, if you didn’t have a repeat surgery, what can you expect after 10 years, and will you outcomes be any better than under the care of a competent physician who truly understands low back pain (like maybe a chiropractor….)?  This is the question that was asked in this particular study.  Researchers followed 473 patients with chronic low back pain of at least 1 year’s duration who were all considered candidates for spinal fusion.  The average follow-up was 11 years.  The patients were put into one of two groups:

  1. Lumbar spine fusion with either instrumented or noninstrumented fusion.
  2. Nonoperative treatment that included multidisciplinary cognitive-behavioral and exercise rehabilitation.

Keep in mind that true management in the #2 scenario above is not done by the average practitioner.  Rather, this is a comprehensive approach encompassing both your mental state, the way you related (or don’t relate) to your pain as well as the physical treatments that can go a long way towards reducing the level of pain.

So what did the researchers find out after 11 years about the differences between spinal fusion and the comprehensive approach?


Yup.  No difference in the long run.  And this does not take into account the fact that a lumbar fusion will lead to further degeneration of the levels above and below as well as the chance that the surgery will not relieve the original symptoms it was attempting to address.

The bottom line is that surgery really should absolutely, positively be your last resort.  And THEN you still try something else before surgery.  You need to make sure that you can look yourself in the eye 6 months after surgery and tell yourself that you tried everything else before surgery.  And yes, this DOES include chiropractic.


James Bogash

For more than a decade, Dr. Bogash has stayed current with the medical literature as it relates to physiology, disease prevention and disease management. He uses his knowledge to educate patients, the community and cyberspace on the best way to avoid and / or manage chronic diseases using lifestyle and targeted supplementation.