Once again as I read the posts on this site I am amazed at how unfortunately ignorant the patient population is to much of the care available to them (even in the age of Web MD). That being said, it is NOT the fault of the patient when the only solution to spine pathology presented to them by suposed learned surgeons is fusion. We know the dismal results of this procedure and while other treatment options exist, endoscopic discectomies, ADR's, etc., because of the trial lawyers, FDA, and insurance companies, surgeons will more often than not recommend the only thing they get paid for...fusion-even as these other therapies are available. I've talked about this before on this post, my practice is full of patients that have failed surgical therapy, or the surgeon refuses to address adjacent level (fusion) degeneration. I can often improve the patients clinical picture with minimally invasive surgical or interventional procedures, but there are other times when more extensive surgery is needed (like in the case of ADR)...but if you're not getting paid for them, and may infact may get sued for doing an "experimental" treatment, it is hard to argue against performing a tried and true albeit archaic procedure like fusion. So Mark, to address one of your other posts about "depression," it may well be that the interventionalist (pain doctor) is out of interventional options and the surgeon simply will not address the issue-I see it all the time.
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