Is technology in spine surgery always a benefit when decompressive procedures alone prove equally effective and less burdensome?
I have been interested in the spine since 1992, the year in which my specialization in neurosurgery in Italy began. I had the opportunity to witness the beneficial results of spinal microsurgery successfully started in the 1970s. However, subsequently, I have seen the deterioration of spine surgery since 2000 when decompressive microsurgery became increasingly replaced by prosthetic implants for disc rupture and stabilization at 360°. To date, nevertheless, the results in the scientific literature confirm that in most cases, only decompressive techniques are warranted. Further, they have proven to have lower risks and costs versus macroinvasive decompression combined with major fusions.
In this jagged panorama of therapeutic options, the patient finds himself lost. So are the family doctors who do not know where to direct their patients. Yet, the instrumentation methods proliferate, and unnecessarily and illusively bypass microsurgical procedures/decompressions alone. In my research of the international literature, I found an interesting and brilliant article on PubMed comparing lumbar decompression alone versus decompression with 360 degree transforaminal lumbar interbody fusion (TLIF) by Nancy E. Epstein, M.D., (Surg Neurol Int. 2018 March 7;9:55). It readily documented lower complication and reoperation rates for laminectomy rather than TLIF/MI TLIF/other fusions for degenerative lumbar disease with/ without degenerative spondylolisthesis:
I was struck and comforted by the fact that my considerations were, in this article, exactly matched by Nancy Epstein, demonstrating that patients suffer from disc and degenerative lumbar pathologies may be effectively managed with spinal decompressive alone without fusion.
I also greatly appreciated her courage and honesty in denouncing the economic interests that may be behind those performing other surgeries (TLIF/MI TLIF) using major prostheses/ instrumentation devices.