Fusion Surgery: Blowing the Whistle

It's time we set something straight once and for all. Back fusion surgery is crippling those with back pain. And it doesn't have to be that way.

Every ten seconds in the United States, someone will go to the hospital with a back pain complaint. That's well over three million emergency room visits every year.

About one in five will be admitted for treatment including over 450,000 fusion surgeries. Total inpatient cost of these treatments will exceed $9.5 billion dollars — now the 9th most expensive condition treated in U.S. hospitals.

What really aggravates the fire out of me is how many of these patients admitted into the so-called "best healthcare system in the world" will then be ushered into operating rooms for a spinal fusion surgery... and come out worse than they went in.

Heck, back surgery is the only category of surgery with its own clinical name for failure: Failed Back Surgery Syndrome.

Now you may think a failed back surgery simply means it didn't relieve your pain. And with an average bill of $80,000 for a complex fusion surgery that's sure going to hurt your wallet even if you have insurance.

But the real risk is that fusion surgery can make you worse... much worse. Here's some statistics on spinal fusion surgery that makes my point:

• 13% of patients will be back in the hospital within 30 days
• 20% will need another surgery within 10 years
• Risk of stroke is double that of decompression surgery
• Risk of death is double that of decompression surgery

Don't get me started on "improved surgical techniques" either. Reoperation rates within one year of having surgery has increased by 40% since the early 1990s. Yet the number of complex fusion surgeries performed every year has increased 1500 percent in just five years (2002 to 2007).

But that's not the worst of it. When fusion surgery is compared to nonsurgical treatments like physical therapy and exercise, end results of fusion surgery don't even come close. And isn't that why people get the surgery in the first place — results?

A couple months ago a new study published in Spine compared the success of lumbar fusion surgery with nonsurgical treatments using Ohio workers' compensation data. The study reviewed outcomes two years after the surgery (725 surgery patients) or injury (725 nonsurgical patients). Guess who ended up better off?

With such horrendous results, any idea why so many back pain sufferers are even offered fusion surgery?

Bloomberg Newsweek has an idea...

Doctors Are Getting Rich...
Off the Backs of Their Patients

According to an investigative article published in Bloomberg Newsweek earlier this year, spine surgeons are the highest paid members of the medical profession. Their average annual salary of $806,000 is more than triple what pediatricians earn thanks in large part to fusion surgery.

Believe me, I have no problem rewarding someone for hard work. And I'm sure it takes a lot of hard work to get through medical school, internship, and begin a medical practice. But that doesn't excuse getting paid to offer what is looking more and more like a potentially harmful sham treatment.

Look, even the surgeons themselves recognize that fusion surgery fails to get results.

Spine surgeon Sohail Mirza, who chairs the Department of Orthopaedics at the prestigious Dartmouth Medical School, told the Bloomberg reporters: "It's amazing how much evidence there is that fusions don't work, yet surgeons do them anyway, the only one who isn't benefitting from the equation is the patient."

So let's see if we've got this...

• Spinal fusion surgery doesn't work, meaning...
• Patients don't benefit from it, and may be harmed, yet...
• Doctors are getting rich off the proceeds, so...
• Avoid spinal fusion surgery.

Ok, I think we've got it.

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References

Agency for Healthcare Research and Quality. Aching Back Sends More Than 3 Million to Emergency Departments. 2011 Feb 2.

Nguyen TH, et al. Long-term outcomes of lumbar fusion among workers' compensation subjects: a historical cohort study. Spine. 2011 Feb 15;36(4):320-31.

Deyo RA, et al. Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA. 2010 Apr 7;303(13):1259-65.

Atlas SJ, et al. Long-term outcomes of surgical and nonsurgical management of lumbar spinal stenosis: 8 to 10 year results from the maine lumbar spine study. Spine. 2005 Apr 15;30(8):936-43.

Martin BI, et al. Are lumbar spine reoperation rates falling with greater use of fusion surgery and new surgical technology? Spine. 2007 Sep 1;32(19):2119-26.

Deyo RA, et al. United States trends in lumbar fusion surgery for degenerative conditions. Spine. 2005 Jun 15;30(12):1441-5; discussion 1446-7.

Martin BI, et al. Reoperation rates following lumbar spine surgery and the influence of spinal fusion procedures. Spine. 2007 Feb 1;32(3):382-7.

Kalichman L, et al. Spinal stenosis prevalence and association with symptoms: the Framingham Study. Spine J. 2009 Jul;9(7):545-50.

S. Samuel Bederman, et al. The who, what and when of surgery for the degenerative lumbar spine: a population-based study of surgeon factors, surgical procedures, recent trends and reoperation rates. Canadian Journal of Surgery. 2009 August; 52(4): 283-290.

Waldman P, Armstrong D. Bloomberg Businessweek. Doctors Getting Rich With Fusion Surgery Debunked by Studies. 2011 Jan 5.