An article on the front page of the Washington Post, Spinal fusions serve as case study for debate over when certain surgeries are necessary, captured my attention this morning. I’m excited to see that the mainstream media is reporting on the issue of overdiagnosis and overtreatment, and this article is one of a series of reports called The Cost of Healing: How America Puts the Wrong Price on Healthcare by Peter Whoriskey and Dan Keating .
In the article they cover how:
- the number of spinal fusion surgeries has increased dramatically over the last 20 years
- audits show that many of these surgeries are unnecessary because they either do not help the patient or they result in increased pain and disability (harm)
- doctors may not be discussing the potential harms the surgeries may cause or offer other less-invasive options to patients
- the costs for spinal fusion surgeries have increased, benefiting hospitals, doctors and medical equipment suppliers
- the policy statement of the International Society for the Advancement of Spine Surgery states that there may be “overuse procedures beyond what the current state of medical evidence really supports”. Click here to read the entire ISASS policy statement. I thought it was interesting to read their recommendations for the conditions when lumbar fusion is medically indicated, indicated on a case-by-case basis, and not medically appropriate.
I believe one of the reasons for the increase in these surgeries is that patients are requesting them because they’re in pain and they want it relieved quickly which is totally understandable. While these surgeries do benefit some people, there are too many cases where it does not and they are being done despite the lack of medical evidence showing benefit.
In the article, there was an example of a man who had been operated on “four or five times” and didn’t seem to understand why he had to have these procedures other than the doctor told him that if he didn’t have the operation he’d have been paralyzed. When this particular doctor’s records were reviewed by board-certified neurosurgeons, the findings were that 9 out 10 of the spinal fusion surgeries he performed were medically unnecessary. I wonder how many resulted in more harm than good for the patient?
Patients are people too!
If your doctor is recommending spinal fusion surgery for low back pain, ask about the risks if you have the surgery. Also, what are other less-invasive options that medical evidence has shown will benefit the patient? Ask questions and learn as much as you can so you feel confident that the treatment you decide to have is the best one for you.