The other thing about spinal fusion, is the infamous domino effect. There are indeed 24 vertebrae and 23 discs from the occiput down to the sacrum and they are all designed to work in unison to enable us to bend forward or backward, rotate and move side-to-side. Any time one level is fused its burden will have to be born by the adjacent levels hence the following domino effect: any time a disc is fused the adjacent levels have to pick up the slack and start deteriorating faster until they soon need fusion themselves. The peak age of back and neck injuries is 35 to 45, the height of work productivity. If a fusion is started at that age, every 3-5 years the patient will need another one, following the domino effect. Here goes work productivity and here comes Social Security Disability. About 40% of people on SSDI have "failed" back surgeries.
Many more of these procedures are performed in the US as compared to Western Europe and exponentially more than the rest of the world, largely because secondary gains and healthcare systemwide profits: surgeons, hospitals, radiologists, device manufacturers, lawyers, etc. I knew a lawyer once who told his client my patient once: "If you do not get this neck fusion, you will not have a case". It literally was not his neck on the line so he had nothing to lose. This sort of arm twisting is done routinely: lawyers pushing their clients to go under the knife, whether they need it or not, for their own monetary gain.
The truth is that even the best $3000 titanium screw (that costs $275 to make) cannot heal like a human vertebra or disc can. The minute this screw is in, that patient's anatomy is changed forever. If we believe the obvious premise that one's own God-given anatomy is best and better than any human remodeled one, changing this anatomy irreversibly and irreparably in your 4th or 5th decade can only spell trouble, especially in an era where people reach their 10th decade routinely. If that screw moves or breaks or gets bent because of a subsequent injury, or becomes the seed of a systemic infection, it will NOT heal, it will just have to be replaced by spare parts in another surgery and so on and so forth.
My longest patient (25 years) is a textbook illustration of what a fusion nightmare can be. I saw her first in her early 30s and she already had a couple of whiplash injuries in auto accidents and her neck looked like 45. We tried everything conservative but nothing worked and minimally invasive procedures were not very fashionable at the time. So I referred her to one of the best neck surgeon's in Manhattan whom I knew personally for scrubbing with him. Neck fusion was performed on two levels and went well except...a few months later one level did not fuse despite the rigid bracing and all that (second third of odds her body's response). Here she went for another fusion of that same level. A year or two later she had another MVA and she ended up requiring a third cervical level fusion (third third of odds: you do not know what the future will bring). She went on like that between new accidents and new fusions and now she is fused from the back and the front from C3 to C7 (the entire neck practically) and she is barely 54 years old! I am skipping all the pain procedures, medications and tests she required over these years and how it all affected her life greatly as you can imagine.
I will end this blog on a sweet and sour note. One of the first joke my orthopedic attending told me when I started training in this country at a Yale hospital goes like this: If you have 5 orthopods in a room how many advices do you get about a case? 6 because by the time you ask the fifth, the first one you asked has changed his mind!
So the morale of this story is: Go for a second, third, fourth opinion...keep going till somebody tells you you do not need the fusion and go with that one.