Unnecessary Back Surgery On The Rise

Many billions of healthcare dollars are spent annually on back surgeries that provide little if any benefit for patients.

 Many times I have had people tell me that they have x-rays or MRI, etc. showing hairline fractures, bulging discs, etc. which their M.D. insist prove that they need back surgery.

What their doctors are not telling them is that there are many other people their age with just as many hairline fractures, bulging discs, etc. who are not in pain at all. 

With obvious exceptions like broken backs or crushed vertebra, it is usually best to go with a “wait and see” approach or minimally invasive approaches and reserve surgeries for cases that do not improve over time and where there is strong proof that the surgery is effective.

Too many complex back surgeries are being done and people are suffering as a result, according to a study in the current issue of the Journal of the American Medical Association. The general tendency noted in the study — that many patients and doctors think more medical care is always better — has implications for the new health overhaul law.

Back pain associated with aging can be treated in one of numerous ways: rest and physical therapy, surgery to remove the bony growths that can push on nerves, fusing two vertebrae together, or fusing many vertebrae together.

In the past few years, several studies have failed to show a big advantage for surgery — especially for complex surgery. Researchers from Oregon Health and Science University and several other places looked at Medicare billing records to see whether the rates or type of back surgeries went down as a result.

They found the number of surgeries has gone down very slightly. But when they looked specifically at complex surgeries, they found a big difference.

“The most complex type of back surgery has increased dramatically between 2002 and 2007, with a 15-fold increase,” says co-author Richard Deyo. In 2002, the rate of complex surgery was 1.4 per 100,000 people in Medicare. It jumped to 19.9 per 100,000 just five years later.

Deyo and his colleagues also checked the rate of complications. “This more complex form of surgery is associated with a higher risk of life threatening complications,” he says. Among people who just had the bony growths removed (a surgery called decompression), 2.3 percent had problems associated with their treatment, such as a heart attack, stroke or pneumonia. The complication rate was 5.6 percent among people who had multiple vertebrae fused together.

Deyo says there’s no reason to think people suddenly started developing the spinal deformities that justify the complex surgeries. He offers several possibilities for the upswing. “Many surgeons genuinely believe that the more invasive procedures offer some benefits,” he says. “But certainly there are important financial incentives at play as well.” Surgical fees for simple decompressions are about $600 to $1,000. The complex surgeries earn surgeons as much as 10 times more. He says another possible factor is the tendency for both doctors and patients to go for a new, more expensive approach just because it sounds better….

James Weinstein is also calling for a rejiggering of financial incentives. Weinstein is an orthopedic surgeon and the director of the Dartmouth Institute for Health Policy and Clinical Practice. He did some of the original studies showing that most back surgeries make a minimal difference, if any. He says Deyo’s study shows one thing clearly. “The practice of medicine doesn’t always follow the best evidence,” he says…

more via Unnecessary Back Surgery On The Rise, Study Says : NPR.

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