Fusion Surgery Debunked by Studies In the 12/30/2010 Businessweek, Peter Waldman and David Armstrong cover the controversy surrounding spinal fusion, a complex and costly surgery that is being performed far more frequently than necessary to treat back pain with inconsistent relief of symptoms.  The article covers the significant financial incentive to surgeons to perform this surgery, and the fact that surgery is frequently performed (with great financial benefit to the surgeon and hospital) despite evidence that fusions do not work.  The Federal Health Care Cost and Utilization Project is quoted as demonstrating that the number of fusions has doubled to 413,000 between the years of 2002 and 2008 at a cost of $34 billion.  [A geographical analysis of 2003 data for Medicare utilization shows that spinal fusions are being performed at 1.5 to 4 times the national rate in Western North Carolina:  United States Trends and Regional Variations in Lumbar Fusion Surgery 1992-2003.  Spine 31(23) 2006:  2707-2714]  For spinal stenosis, a condition that can often be treated with simple decompression surgery, a 2010 study published in the Journal of the American Medical Association demonstrated that spinal fusion is too frequently performed, at great expense, with potential complications, and questionable results.  The chair of the Department of Orthopedic Surgery at Dartmouth, Sohail Mirza, MD, is quoted "It's amazing how much evidence there is that fusions don't work... yet surgeons do them anyway."

For Back Pain, Surgery Can Be Less Than a Fix - As operations soar, some doctors urge old-school care. In the 11/5/2010 St. Petersburg Times, Richard Martin, wrote about the increasing use of complex surgery and the common occurence of "failed back surgery syndrome."  Nearly everyone experiences back pain at some point in their life, and more Americans are going for what they think may be the ultimate fix: surgery.  However, many patients are worse off having had the surgery.  Martin reviews the indications for having surgery, as well as article that raise questions regarding surgery.  He even covers the subject of laser spine surgery [which is a common question for many of my patients from Florida.]

Importance of physical exam cannot be underestimated. In the 2/12/2009 New York Times Doctor and Patient Column, Pauline W. Chen, MD, wrote about an interview with "Dr. Abraham Verghese, the critically acclaimed author of two nonfiction books and a professor of medicine at Stanford University" on "the importance of the physical exam, or what he refers to as 'bedside skills,' in modern medical practice." He noted that physicians "order a lot of tests" thinking they "are saving time or because [they] are uncertain." But, spending "more time listening to a patient or being more thoughtful" will "end up saving time," Dr. Verghese argued. And, in spite of "the limitations of the physical exam," he stated that it "is an important ritual whose" significance "has diminished for doctors because we have other ways of getting information."

Experts question effectiveness of surgery for back pain. The 1/9/2009 Los Angeles Times reported, "An aching back -- a dull twinge or a stabbing pain, lasting days or years -- is a source of annoyance, misery, or even disability for millions of sufferers." In fact, "80 percent of the population will experience back pain at some point in their lives, and while the majority of cases resolve quickly, 30 percent recur, according to the North American Spine Society." The group also estimates that Americans spend over "$80 billion" annually on treatments for back pain. But, some experts say that "expensive treatments and surgeries...may not help patients much." They even "argue that doctors need to think more before they resort to the knife," and "note that the US has, by far, the highest frequency of back surgeries among developed nations: There are approximately 1.2 million spinal surgeries in the US each year, double the rate in those other countries."