Are you a good candidate for spinal fusion?

The use of spinal-fusion surgery has increased drastically in recent years, from 150,000 procedures in 1993 to 300,000 in 2001. Although many long-established uses exist for spinal fusion--for the treatment of severe scoliosis, spinal tuberculosis, and vertebral fractures--doctors are increasingly using it to treat back pain resulting from degenerative changes in the spine, disk disorders such as herniated disks, and spinal stenosis. However, there is no convincing evidence that spinal fusion works for most patients with back pain from these conditions.

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If your doctor recommends spinal fusion for treatment of degenerative changes, a herniated disk, or spinal stenosis, how do you know if you're actually a good candidate? First, you should have severe disability from your back pain--for example, being unable to perform activities of daily living (such as dressing or bathing yourself) or to do your job. Second, you already should have tried conservative care--such as self-treatment, pain relievers, and exercise--at least for six months without success. Third, the back problem should be localized, that is, confined to a small area (one to two levels) of the spine, with no associated deformity.

In addition, potential candidates for spinal fusion should have no significant psychosocial problems. Research has consistently shown that people with back pain who have problems such as depression, large debts, an unhappy marriage, or jobs that involve repetitive manual labor do not experience improvement in pain after a fusion. Their pain tends to be magnified because of their psychological issues, and fixing the physical problem has little benefit. These patients should instead seek psychological counseling.

Although studies have not clearly shown that spinal fusion is effective for spinal degenerative changes, herniated disks, or spinal stenosis, some people with these conditions report pain relief from the procedure. To reduce your odds of undergoing a surgical procedure that will provide no benefit, get a second opinion before yielding to the knife.