"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Wednesday, February 6, 2013

Spinal Fusions and Bone Graft Complications

Spinal Fusions and Bone Graft Complications
In the United States, a growing number of people suffer from debilitating back pain from degenerative diseases like arthritis. Spinal fusions and bone grafts – pieces of bone from the patient or donors or synthetic bone – are often used to treat back pain caused by slipped disks or damaged bones in the spine that can irritate nerves. In the United States, about 432,000 spinal fusions are done every year. A spinal fusion is a surgical procedure where surgeons take damaged bones in the spine called vertebrae and fuse them together to eliminate pain caused by irritated nerves.

As with any medical technology or procedure, however, spinal surgery and bone grafts do carry the risk of complications. If you are considering this type of surgery to relieve back pain, you may wish to discuss the risks and benefits with your doctor or consider alternative treatments for your back pain.

What is a Bone Graft?
Bone grafts are used to help bones heal and can be pieces of bone taken from a patient's own body or from a donor. The majority of bone grafts – 84 percent – are used in spinal fusions. One of the most recent advances in back surgery is the invention of synthetic bone grafts known as bone morphogenetic proteins (BMPs). One type of BMP is manufactured by Medtronic under the brand name INFUSE. It is approved by the Food and Drug Administration (FDA) for limited use in specific types of spinal surgery.
These proteins are powerful hormones that encourage new bone to grow faster and are used with titanium hardware that stabilizes the vertebrae as the bone grows. Using BMP eliminates the need for painful surgeries to harvest bone in the patient or donated bone that may harbor infection or disease.

The Risks of Spinal Fusion Surgery
All forms of surgery have their complications, and spinal fusion is no different. Some of the general surgical complications include blood clots, infection, lung problems and anesthesia complications.
Spinal fusion can also lead to loss of mobility in the spine because the vertebrae are fused together, making this option unattractive to younger, active people. The disc surrounding the fused vertebrae may also deteriorate quicker because of extra stress, and more surgeries will be needed to repair these discs.

Some specific spinal fusion complications include:

  • Hardware fracture.Sometimes the hardware used to support the bones while they heal can break; this requires surgery to remove.
  • Implant migration. The implant can move from where it was placed by the surgeon; this can cause damage to the spine or blood vessels.
  • Spinal cord injury.
  • Persistent pain.
  • Sexual dysfunction.
  • "Failed back surgery syndrome." There is a 20 percent risk that spinal fusion will not relieve back pain. Also, some vertebrae may not fuse together properly and can create what is called pseudoarthritis.

In addition to these complications, the new synthetic bone grafts used in spinal fusion also come with their own problems. In 2011, Dr. Eugene Carragee published a review revealing that BMP products like INFUSE have a 43 percent higher complication rate than previously published. Complications like crippling back and leg pain, and ectopic bone formation (unwanted bone in the spinal canal) have caused a number of individuals to file lawsuits against Medtronic claiming the INFUSE bone graft is a faulty product.

Non-Surgical Alternatives to Spinal Fusion Surgery
Before undertaking spinal fusion surgery, there are some alternatives that you might wish to explore when talking with your doctor. According to Dr. Stewart G. Eidelson, less than 5 percent of people with a spinal disorder require surgery.

Spinal stenosis and degenerative back problems can be treated non-surgically with treatments, including:

  • Medication that can reduce inflammation, muscle spasms and pain. Though, these are not without side effects.
  • Epidural injections can deliver steroids to the space surrounding nerve roots and help reduce pain in the arms or legs.
  • Physical therapy is also effective in managing back pain. A combination of inactive therapy – ice packs, ultrasound, massage and electric stimulation – and therapeutic exercises, including stretching and exercises to strengthen muscles and make them more flexible, may be prescribed.

If your doctor recommends spinal fusion surgery for your low back pain, you should get a second opinion if you are concerned about the possible risks. As always, make sure you discuss all options with your doctor, along with the benefits and risks.

Michelle Y. Llamas is a content writer for Drugwatch.com. She educates consumers about dangerous drugs and defective medical devices.

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Tim Richardson, PT owns a private practice at Medical Arts Rehabilitation, Inc in Palmetto, Florida. The clinic website is at MedicalArtsRehab.com.

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Tim has implemented a computerized Clinical Decision Support (CDS) system in his clinic since 2006 that serves as a Reminder, Alerting, Prompting and Predicting CDS using evidence-based tests and measures.

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