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Why Would Two Patients with No Disease Be Offered Unnecessary Transforaminal Lumbar Interbody Fusions (TLIF)?

Professor of Clinical Neurosurgery, School of Medicine, State University of New York at Stony Brook, New York, and Chief of Neurosurgical Spine and Education, NYU Winthrop Hospital, NYU Winthrop NeuroScience/Neurosurgery, Mineola, New York 11501, United States.
Corresponding author: Nancy E. Epstein, M.D., NYU Winthrop Hospital, NYU Winthrop NeuroScience/ Neurosurgery, 200 Old Country Rd. Suite 485, Mineola, NY 11501, United States.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

We are seeing more and more patients undergoing unnecessary trigger point injections, or more critically, epidural injections (ESI) performed by various specialists (neurosurgery, neurology, orthopedics, pain management, anesthesia, radiologists/neuroradiologists).

We are also witnessing a huge increase in unnecessary transforaminal lumbar interbody fusions (TLIF) being offered to patients with no disease (i.e. pain alone with no neurological deficit, or abnormal radiographic (MR/CT) findings). In fact, we just saw two such cases within one week.

Both patients were middle aged, and had undergone several ESI/yr for many years and were now being offered single or multilevel TLIF by both neurosurgeons and orthopedists.

Case Description

Two middle-aged patients complained of low back pain for over a decade. Both patients had received multiple ESI per year for many years. Both had normal neurological examinations, and both had MR and/or CT studies showing no “surgical” spinal disease (e.g. minimal non focal degenerative changes). Nevertheless, both patients were offered single or multilevel TLIF by several neurosurgeons and/or orthopedists.

Ultimately, both patients were convinced to go to neurology for conservative non-surgical management. Nevertheless, they had a myriad of questions that included: how could surgery be recommended if I did not need it? Why did their physicians say that a fusion was necessary? Why did they say surgery was needed if the examination and X-ray studies were normal?

How can we stop this TLIF epidemic?

What would you have done? We look forward to the participation of our readers.

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Conflicts of interest

There are no conflicts of interest.


The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of the Journal or its management.

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