Worldwide perspective Failed back syndrome

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ct scan showing 2 views of l4-5 disc herniation


a report spain noted investigation , development of new techniques instrumented surgery of spine not free conflicts of interest. influence of financial forces in development of new technologies , immediate application spine surgery, shows relationship between published results , industry support. authors have developed , defended fusion techniques have published new articles praising new spinal technologies. author calls spinal surgery american stock , exchange , bubble of spine surgery . scientific literature doesn t show clear evidence in cost-benefit studies of instrumented surgical interventions of spine compared conservative treatments. has not been yet demonstrated fusion surgery , disc replacement better options conservative treatment. s necessary point out @ present there relationships between industry , pain, , there industry of pain . nonetheless, market of spine surgery growing because patients demanding solutions problems. tide of scientific evidence seems go against spinal fusions in degenerative disc disease, discogenic pain , in specific pain. after decades of advances in field, results of spinal fusions mediocre. new epidemiological studies show spinal fusion must accepted non proved or experimental method treatment of pain . surgical literature on spinal fusion published in last 20 years establishes instrumentation seems increase fusion rate , instrumentation doesn t improve clinical results in general. still in need of randomized studies compare surgical results natural history of disease, placebo effect, or conservative treatment. european guidelines lumbar chronic pain management show strong evidence indicating complex , demanding spine surgery different instrumentation used, not more effective simple, safer , cheaper posterolateral fusion without instrumentation. recently, literature published in field sending message use minimally invasive techniques ; - abandonment of transpedicular fusions. surgery in general, , usage of metal fixation should discarded in cases.


in sweden, national registry of lumbar spine surgery reported in year 2000 15% of patients spinal stenosis surgery underwent concomitant fusion. despite traditionally conservative approach spinal surgery in sweden, there have been calls country more aggressive approach lumbar procedures in recent years.


cherkin et al., evaluated worldwide surgical attitudes. there twice number of surgeons per capita in united states compared united kingdom. numbers similar sweden. despite having few spinal surgeons, netherlands proved quite aggressive in surgery. sweden, despite having large number of surgeons conservative , produced relatively few surgeries. surgeries done in united states. in uk, more third of non-urgent patients waited on year see spinal surgeon. in wales, more half waited on 3 months consult. lower rates of referrals in united kingdom found discourage surgery in general. fee service , easy access care thought encourage spinal surgery in united states, whereas salaried position , conservative philosophy led less surgery in united kingdom. there more spinal surgeons in sweden in united states. however, speculated swedish surgeons being limited compensation of 40–48 hours week might lead conservative philosophy. should noted there have been calls more aggressive approach lumbar surgery in both united kingdom , sweden in recent years.








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