Spinal fusion surgery is becoming an increasingly popular recommendation for patients suffering from a number of back ailments including spinal stenosis and degenerative disc disease but how necessary is surgery for these patients? The answer may surprise you.
Spinal fusion surgeries, which involve joining two or more vertebrae, have risen at a rate higher than any other notable inpatient procedure since 1998. In fact, the rate at which surgeons have recommended and performed spinal fusion surgeries rose 137% annually between 1998 and 2008. By comparison, surgical procedures such as hip replacements and knee arthroplasty increased just over 11%.
With the overwhelming increase in spinal fusion surgeries, questions have arisen as to how necessary the surgery really is. Members of the North American Spine Society have questioned the value of performing spinal fusion surgery for pain from degenerative conditions like stenosis and degenerative discs and in fact, say that spinal fusion surgery is rarely the answer for anything other than severe scoliosis, spinal tuberculosis, fractures and spondylolisthesis. In an effort to pinpoint the validity of so many surgeries, they assembled a multidisciplinary group to examine several observations surrounding spinal fusion surgeries including: the overuse of spinal fusion surgery, spinal fusion surgery for discogenic pain, overuse of spinal instrumentation, published findings for the evaluation of spinal fusion surgeries, vision loss after surgery, placebo-controlled trials and more. The findings seem to show that spinal fusion is indeed overused and that much of the increases in fusion surgery rates come from a rise in surgeries on older adults with spinal stenosis and from patients suffering from discogenic pain.
So why the increase? Sadly, in many cases, the answer seems to be for profit. One surgeon, Dr. Federico Vinas in Daytona Beach, FL was earning as much as $1.9 million a year, largely in incentives given to surgeons for each procedure they performed over a certain threshold. Dr. Vinas at one point was performing three to four surgeries a day and a review by the hospital where he worked showed that he was nearly five times as busy as other neurosurgeons. While to some at the hospital, this indicated that he was a star surgeon, it ultimately raised a red flag with hospital auditors who wondered if all the surgeries were necessary. In 2010, the hospital paid for an independent review of Dr Vinas’ cases, as well as two other neurosurgeons regularly performing spinal fusions. According to the study, which was conducted by board-vertified neurosurgeons working for AllMed, a company that audits health care business, nine of the 10 spinal fusions they examined that had been performed by Vinas were found to be unnecessary. Dr. Vinas and his attorney maintain that he would not perform unnecessary surgeries and he is still employed at the hospital.
Unfortunately, this is not unusual, and the rate at which spinal fusion surgery is performed continues to grow. In 2011, more than 465,000 spinal fusion procedures were performed in the US, according to government data and some experts believe as many as half were unnecessary but proving that to be true, while the data is compelling, can be tricky. By some estimates, patients in the US are spending in the billions of dollars every year for unnecessary surgeries, a theory which has been validated by Medicare. One audit done by Medicare, specifically to determine how much money was improperly spent on spinal fusions showed that in 2011, more than $200 million inappropriately went to spinal fusion surgeries, many times because less invasive or more conservative course of treatment had not been tried first.
Perhaps the worst part of the overuse of spinal fusion surgeries is seen in the patients who undergo them. Many times, the surgery not only does not improve the patients condition, but actually makes it worse, a component of the argument that has reached even the attention of Congress. In 1994, the Agency for Health Care Policy and Research developed by Congress, published a set of guidelines on back pain, which by and large discouraged spinal fusion surgery. “For several low back disorders, no advantage has been demonstrated for fusion surgeries and complications are common,” researchers concluded. The findings were met with a mix of support and anger. The growth in spinal fusion surgeries in the US has been much faster than other surgeries to address wear and tear and Americans are far more likely to undergo the procedure that those from other countries. While controversies swirl around the validity of all the spinal fusion surgeries being performed in the US, even the International Society for the Advancement of Spine Surgery has issued a caution in its policy statement on lumbar fusion, saying that “the varying rates of spine surgery suggest a lack of collective adherence to the state of medical evidence.”
One thing that many medical professional societies and experts agree on is that common problems of the lower back such as spinal stenosis, herniated discs and disc degeneration have far better treatment options that are safer and less expensive.
For any patient that is considering surgery, conservative treatment including manual or physical therapies should be the first course of action. If you have tried other treatment plans that have not worked, please contact the Georgia Chiropractic Neurology Center for a consultation. Experts in soft tissue work, chiropractic care and neurological rehab, Dr. Marc Ellis and his team are leaders in the field and specialize in treatment plans that combine all three of these important factors into a care plan that leads patient after patient ease from their pain and amazing results.
If you or a loved one are suffering from back pain and would like to learn more about the benefits of non-surgical, non-invasive and drug-free care, please contact Dr. Marc Ellis at the Georgia Chiropractic Neurology Center today.