In the treatment of pain caused by medullar compression for low back spine stenosis, the interventions of surgical decompression are often used, and in patients presenting listhesis or scoliosis, with consequent vertebral instability, the blocking of 2-3 vertebras is also present. Using the data from Medicare, some researchers have evaluated the frequency of complications of these surgical procedures from 2002 to 2007, a period during which the frequency of vertebral stenosis diagnosis has kept constant; there has been, instead, a clear increase in surgical decompression and vertebral stabilization interventions, even lacking the evidence of spondylolisthesis and scoliosis. In 2007, in a cohort of 32,000 patients, averagely 75 years of age, the rate of major complications has been significantly more frequent in patients treated with complex fusions (front and back accesses, with graft positioning) than in the ones treated with decompression alone (5.2% vs. 2.1%), as well as mortality at 30 days has been higher (0.6% vs. 0.3%). The duration of hospitalizations in case of complex interventions has been three times higher than the ones for decompressions alone.
According to the authors, such an increased frequency in the interventions for vertebral fusion is not justified by a contemporary increase in vertebral diseases, but simply by the performance of newer and newer implantological and orthetic technologies. In the presence of symptomatic vertebral stenosis, it is then necessary to carefully examine surgical therapeutical proposals not to prefer choices directed more by market than by the patient’s real need.
