Despite what you may hear from the spine surgical community there is an increasing controversy of what role spine surgery, and specifically spinal fusion, should play in the management of back pain in the future. Spinal fusion surgery has grown at a rate of 9% per year and represents a multi-billion dollar industry. In total, the American spine industry approaches $100-200 billion annually when including all expenses, disability, and work loss according to RAND. To make matters worse, research also suggests as many as 90 percent are unnecessary and ineffective. Back pain sent over 3 million people to emergency rooms in 2008 at a cost of $9.5 billion, making it the ninth most expensive condition treated in U.S. hospitals.
Recently a new wave of data by researchers has revealed the high cost and ineffectiveness of most medical back treatments. Yet these revelations have fallen on deaf ears in the medical profession as the use of opioids, epidural steroid injections, and spine surgeries have radically increased despite these warnings. The number of fusions has grown from just over 200,000 in the year 2000 to over 400,000 in 2008. The promotion of new surgical techniques, hardware constructs and reimbursement schedules from carriers have contributed to the increase. David Spodick, Professor of Medicine at the University of Massachusetts, stated that “Surgery is the sacred cow of our health-care system and surgeons are the sacred cowboys who milk it. Indeed, spine surgery has become the cash cow in the medical world and will only grow larger unless sensibility prevails over profiteering.”
The mean hospital costs alone for surgical decompression and complex fusions ranged from $23,724 to $80,888. When combined with surgical costs, medications, MRIs, rehab, and disability, every spine surgery case approaches $100,000 or more. The direct costs are astronomical and may reach as high as $169,000 for a lumbar fusion and for a cervical fusion as high as $112,480. Research suggests that of the 500,000-plus disk surgeries performed annually, as many as 90 percent are unnecessary and ineffective. Richard A Deyo, MD, MPH has published numerous papers on related topics. He states that this is unsustainable, and yet growing at incredible rates. Deyo noted, "It seems implausible that the number of patients with the most complex spinal pathology increased 15-fold in just six years," and he mentioned one strong motivation included "financial incentives involving both surgeons and hospitals.”
I could go on forever but you’re probably asking yourself “So where is he going with this?” Those of you who know me know that I am not anti-medicine and I’m certainly not anti-surgery. In the properly selected population, spine surgery (with progressive neurologic deficit) and even fusion (for instability) have its place. I have seen great results in some patients and tragic results in others. More than anything else, I suppose this newsletter is a “Caveat Emptor”. Your clients, and perhaps you or your loved ones, have an 80% chance of developing back pain during their lifetime which is bad enough to bring them to a doctor’s office. If the prevailing trend continues, many will advance to spine surgery even though the likelihood of benefit is minimal. Health care consumers need to be made aware of the real risks and benefits of spine surgery before they make a decision based on medical tradition or greed rather than evidence-based medicine and best practices. In the PI world, we need to put our patients/clients well being first. While it may be true that spine surgery will increase a settlement value we all must remain diligent to make sure our focus remains on the patients overall wellness and not just the financial outcome.
For additional information, please email me at Dr.Shaw@ShawChiropractic.com