Various points of view
When assessing the results of an operation, a surgeon and his or her patients may have different points of view. In other words, it is entirely possible that a surgeon has obtained a technically excellent result, even though his or her patient is not the slightest bit happy. Scientists tend to judge operations by the degree to which a complete bony fusion has been brought about. However, it has proven to be extremely difficult to determine the extent to which this has happened, and moreover, success in this respect does not always match the patient’s satisfaction rate (the clinical result).
If the vertebrae are joined purely to reduce backache, the success rate is likely to be 40 to 50%. If patients only suffer abnormalities at one single level and do not suffer any other problems, the success rate may be as high as 80 to 85%, provided that the patients have been carefully selected. These numbers have been like this for years, despite many attempts to select only patients who are sure to benefit from the operation.
Clearly, it remains very difficult to predict how certain patients will respond to this type of surgery, which means that about half of patients undergoing spondylodesis will go under the knife in vain, despite their high expectations. Unfortunately, this may give spondylodesis a bad reputation.
Less impressive results in smokers
Smokers are much less likely to benefit from spondylodesis than non-smokers. They are also less likely to achieve a stable bony fusion. Therefore, surgeons in the United States tend not to perform spondylodesis on patients who smoke. Bergman Clinics' Back and Neck Centre, too, will not perform this type of surgery until it has been established that the patient is not a smoker or has quitted smoking.