More than 100 million Americans suffer chronic back pain, a staggering figure that costs hundreds of billions annually in lost productivity and medical intervention.
Over the past two decades, U.S. patients have increasingly resorted to spinal fusion surgery to deal with chronic back and neck pain, but studies in recent years have shown a surprising outcome: over the long-haul, the surgery is ineffective.
According to the National Institutes of Health, spinal fusions increased by 137 percent between 1998 and 2008, more than any other surgery, including hip replacements, knee replacements and heart bypass.
What is Spinal Fusion Surgery? How is Spinal Fusion Surgery Performed?
Spinal fusion fuses (or welds) vertebrae so they become a single bone. Additional bone is placed between two vertebrae — a procedure known as a bone graft — and metal plates, screws and rods are inserted to hold the vertebrae together.
The surgery is intended to alleviate pain caused by bulging or herniated discs, spinal stenosis (degeneration of the spine often caused by aging) and a variety of other conditions resulting in chronic back pain.
No Long-Term Difference for Surgery Patients
A study published by the National Institutes of Health— which looked at two-year outcomes of lumbar fusion surgery patients versus an equal number of patients with chronic back pain who opted for non-surgical treatment —found the former group had markedly greater rates of permanent disability, complications, future surgeries and opiod use.
In 2007, the non-profit Center for Medical Consumers cited two landmark studies showing that patients who went under the knife for severe back and leg pain caused by a herniated disk saw a quicker respite from pain, but two to four years out there was essentially no difference. Another study cited by the Center for Medical Consumers netted similar results as did a Norwegian trial published three decades earlier.
And the respected peer-reviewed medical journal publisher BMJ (formerly known as the British Medical Journal), which focuses on the evidence-based practice of medicine, published the results of a study comparing the long-term effectiveness of surgical and non-surgical treatment in patients with chronic low back pain. Long-term improvement was no better for spinal fusion patients than it was for those who tried other forms of intervention and exercise.
One leading researcher characterized the increase in spinal surgeries as “excessive,” charging that the phenomenon is “directly attributed to the supply of spine surgeons.”
Back Surgery in America; Are We Going Under the Knife Too Often?
“The rate of back surgery in the United States was at least 40 percent higher than any other country and was more than five times those in England and Scotland,” according to Dr. Richard Deyo, a professor at Oregon Health and Science University and a leading researcher in the inappropriate use of medical technology.
Deyo referenced a 1994 study he and a colleague conducted that compared international rates of back surgery with America’s.
They found that “back surgery rates increased almost linearly with the per-capita supply of orthopedic and neurosurgeons.”
It’s implausible, he added, that “the number of patients with the most complex spinal pathology increased 15-fold in just six years.”
He has suggested that as many as 90 percent of disc surgeries are unnecessary and ineffective.
Financial Gain at Core of Surgery Increase
So why the monumental uptick in surgeries?
Deyo and many others believe that the explanation lies in the money to be made by surgeons and hospitals who perform the procedures.
As reported in a 2006 expose in The New York Times, spinal surgery has become one of the most lucrative areas of American medicine, generating billions for hospitals, doctors and the burgeoning medical device industry.
There are great financial motivators for doctors to recommend spinal surgery, according to the Times, which pointed out that many doctors have skin in the spinal parts makers game. The profit-margin on medical devices is enormous, the story noted, citing a $1,000 price tag for a single spine screw, at least 10 times more than the cost to manufacture it.
University of California at Irvine spine surgeon Dr. Charles D. Rosen was so troubled by the practice of doctors having a financial stake in the products they use that he formed the Association of Ethical Spine Surgeons.
Rosen told the Times that doctors who are paid consultants and/or who invest in the medical devices that they use have a conflict of interest. Using a spinal part that one profits from can “bias the doctors’ choice for what is best for the patient,” he added.