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.
DOI:10.25259/SNI-290-2019Copyright: © 2019 Surgical Neurology International 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.
How to cite this article: Epstein NE. Why Would Two Patients with No Disease Be Offered Unnecessary Transforaminal Lumbar Interbody Fusions (TLIF)?. Surg Neurol Int 25-Jun-2019;10:114
How to cite this URL: Epstein NE. Why Would Two Patients with No Disease Be Offered Unnecessary Transforaminal Lumbar Interbody Fusions (TLIF)?. Surg Neurol Int 25-Jun-2019;10:114. Available from: http://surgicalneurologyint.com/surgicalint-articles/9400/
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.
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.