Wellness Word March 2013 Monumental nationwide increase in spinal fusion

Editor’s note: Wellness Word is an informational column which is not meant to replace a health care professional’s diagnosis, treatment or medication.

A prestigious medical research team from Dartmouth Medical School discovered that  rates of lumbar fusion in the United States have increased more than 250 percent over the past decade.  These rates represent the highest rates of spine surgery in the world, despite incidence and prevalence rates of spine disorders that are similar to those found in other countries.

The lead author, Dr. James N. Weinstein, Chairman of Orthopedic Surgery, Professor and Editor-in-Chief of Spine (a leading peer-reviewed journal), also found that spending for lumbar fusion increased more than 500%. Equally disturbing was a nearly 20-fold variation in regional rates of lumbar fusion. This represents the largest variation seen with any surgical procedure. The research team was unable to find a clinical or scientific reason to explain the increase in the rate of surgery or the large variation among regions.

Another distinguished medical research team speculates that the increase in fusion rates may be related to the recent introduction of spinal cage devices. A spinal cage is a small hollow cylindrical device, usually made of titanium, with perforated walls. Cage devices have been brought forth based on Food and Drug Administration criteria for safety, but there are no clinical trials demonstrating their efficacy or effectiveness.

Fusion with cages increased over 1600% between 1996 and 2001.  Regretfully, the increased use of cages has not improved disability, complication or re-operation rates. Moreover, considering the unimpressive outcomes and the fact that cage device surgeries cost more than non-cage surgeries, the use of this technology is unwarranted.

In light of this medical research, patients with moderate to severe low back (and/or leg) pain might consider a more conservative treatment regime (manipulation and exercise) before considering surgery.


Too Much Salt Is Dangerous.

Current health advice warns against consuming too much sodium. This warning is based on quality research suggesting that eating high amounts of sodium contributes to the development of high blood pressure. Hypertension affects more than 50 million Americans, and the occurrence rates rise with age and obesity. Hypertension also is the leading cause of stroke and contributes to heart attack, heart failure and kidney failure.

We all know salt is essential to life. Without salt, nerves and muscles would cease to function, the absorption of major nutrients would be impaired, and the body would not be able to maintain adequate water and mineral balances. We need some salt, but not too much.

Available evidence shows that as part of an overall healthy diet, Americans should consume no more than about one teaspoon (2,400 mg) of salt a day.  This is the amount recommended by the U.S. Department of Agriculture, the U.S. Department of Health and Human Services, and the American Heart Association.

If you are under the age of 50, are in good health, and have normal blood pressure, your salt intake could slightly exceed one teaspoon. If you are older, are of African American descent, are obese, or have high blood pressure or diabetes, you should limit your sodium intake to no more than one teaspoon a day. People with heart failure or kidney disease are advised to keep their sodium intake below one teaspoon a day.

Many foods are natural sources of salt (e.g., meat and fish), while others contain salt added during processing. The food industry is responsible for adding 75 percent of the salt consumed each day to prepared foods we buy and consume, so we must carefully watch our food selections.


How can I reduce sodium in my diet?

• Read labels.  Some foods are available in a low-salt or unsalted form.

• Take the salt shaker off the table.

• Cook without salt.

• Use salt substitutes (e.g., lemon juice, vinegar and herbs).

• Reduce seasonings that taste salty (e.g., bouillon cubes, meat tenderizer, soy sauce, steak sauce).

• Substitute fresh fruits and vegetables for canned and processed foods.

Avoid canned soups, dry soup mixes, canned or processed meat and fish, ham, bacon, sausage, salted nuts, peanut butter, frozen dinners, snack foods and fast food.

Some drugs also have high amounts of sodium. Carefully read the labels on over-the-counter drugs. If in doubt, ask your doctor or pharmacist.


Dr. Hari Dass Khalsa is a chiropractor specializing in the non-surgical treatment of spinal conditions with offices in the Hawthorne District. Call 503.238.1032.

Wellness Word March 2013 Monumental nationwide increase in spinal fusion

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