Monday, April 26, 2010

Unneeded, Riskier Spinal Fusion Surgery on Rise

The above headline comes from an April 6, 2010 MSNBC article reporting on an April 7, 2010 study in the Journal of the American Medical Association, (JAMA), showing that the number of expensive and risky spinal surgeries continue to rise in spite of the lack of benefit.
According to the MSNBC article the study shows that among Medicare patients costlier and more complex spinal fusion surgeries are being performed at an increased rate for a common lower back condition they note is caused by aging and arthritis.
The study showed that from 2002 to 2007 the rate of more complex spinal surgeries had increased 15-fold with a related increase in complications and deaths. Dr. Eugene Carragee of Stanford University Medical Center, who wrote an accompanying editorial in JAMA commented, "You have one kind of operation that could cost $20,000 and another that could cost $80,000 and there's not good evidence the expensive one is being used appropriately in the majority of cases."
Among some of the more pronounced results of the study was that the death rate from these procedures increases from 2.3% among patients having decompression alone to 5.6% among those having complex fusions. Lead author Dr. Richard Deyo of Oregon Health and Science University in Portland, stated, "All operations aren't the same and some seem to be associated with higher complication rates than others. It's not necessarily true that the more aggressive surgery is better, at least in terms of safety."
In a Business Week article Dr. Deyo offered some form of an explanation for the increase in complex procedures by saying, "There are financial influences at play," he said. "You get paid more for complex procedures."
Dr. Charles Rosen, a spine surgeon at the University of California, Irvine, and founder of the Association for Medical Ethics commented in the MSNBC article, "Too much fusion surgery is done in this country and often for inappropriate reasons." Dr. Rosen also commented that while complex fusions are needed for some conditions, patients "should not hesitate to get a second opinion."

Dale Giessman, DC
350 John Muir Pkwy., Suite 265
Brentwood, CA 94513

Monday, April 19, 2010

Chiropractic care is not just for back pain. This study shows it prevents injuries in athletes.

Research offers hope to hamstrung clubs


April 18, 2010
AFL CLUBS could turn to a recent study on hamstring and lower limb muscle strains in a bid to reduce the number of players sidelined through the league's most common injury.

After West Coast's Daniel Kerr became the latest player to suffer such an injury on Friday night, following the misfortune of Saints skipper Nick Riewoldt and Hawthorn defender Josh Gibson, a study completed by sports injury consultant Wayne Hoskins from Macquarie University could be called upon to help other players avoid such a fate.

Hoskins completed his PhD on hamstring and lower limb injuries, which was published this week in the journal BMC Musculoskeletal Disorders.

He found that such injuries could be dramatically reduced through the inclusion of a sports chiropractor to the traditional medical, physiotherapist, massage and strength and conditioning management approach typical of AFL football clubs.

This would also have a performance and cost benefit to clubs and players, he found.

The study lasted an entire season and involved 59 players from two VFL clubs. It showed that the group which included chiropractic management had a four per cent chance of a hamstring injury and a four per cent chance of a lower limb muscle strain.

The group that received the traditional management only, had a 17 per cent chance of hamstring injury and a 28 per cent chance of a lower limb muscle strain.

In addition, the chiropractic group missed only four matches during the season through hamstring or lower limb muscle strains, compared with 14 matches missed through hamstring injury and 21 matches missed through lower limb muscle strain in the group of players not receiving chiropractic help.

The group receiving chiropractic assistance also had significant reductions in non-contact knee injuries, low back pain and showed improvements in physical components of health, although this was not the goal of treatment.

Hamstring and lower limb muscle strains are the most common injuries in the AFL, with their management of such injuries a source of constant frustration for clubs and players, Hoskins said.

AFL injury surveys show no change in injury rates of this nature in the past 15 years.

''No previous scientific research of this nature on injury prevention has been conducted at the elite level of Australian football, making it a first,'' he said.

''The study concluded that based on the results, consideration should be given for the inclusion of sports chiropractic in the management options of elite footballers.''

Dale Giessman, DC
350 John Muir Pkwy., Suite 265
Brentwood, CA 94513