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."

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Dale Giessman, DC
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