Is Spinal Surgery in Your Best Interest or Your Surgeon"s?
I recently learned that several friends were at various stages of either recovering from or preparing to have back surgery.
Having known people in the past who had surgery and who consequently experienced very little in the way of relief from their back pain I started to wonder at the efficacy of back surgery, in particular laminectomies.
What I leaned painted a clear picture of the confusion that patients likely feel when trying to decide on a course of action to heal their back pain.
Part of the confusion is caused by how success rates for surgeries of this type are determined.
While patients may consider a success any improvement in their pain level, surgeons have a different way of looking at it.
If you are convinced you need surgery but can't afford it or don't have coverage perhaps there are other less expensive and more holistic approaches you should look into.
While they may not be covered by insurance yoga therapy (be sure the teacher you pick is qualified) massage and acupuncture can and do work regardless of what medical professionals may say about alternative therapies.
Perhaps the medical community is not as honest with their statistics as they may seem...
and maybe their judgment could be clouded by economic decisions and not the quality of life of their patients.
In the past 20 years, the number of surgeries has skyrocketed and the cost per procedure has tripled.
If you live in the US you are five times more likely to be prescribed back surgery than if you lived in the UK, and 40% higher than any other country in the world! According to national data the rate of spinal fusions in the US is about 150 per 100,000.
In Australia close to 50 per 100,000; in Sweden about 40 per 100,000; and in Britain it is lower still, closer to 30 per 100,000.
Since the introduction of high tech gadgetry to the array of available medical equipment in the early 90's the number of surgeries has increased to 465,000 nationally in 2011 from only 56000 in 1994.
Surgical costs have, on average, gone from about $40,000 in 1992 to over $110,000 in 2012.
I think it is something of an economic anomaly that right after new technology was introduced to the marketplace (better and more expensive laminectomy equipment) the medical need suddenly tripled? Could this be a case of "if your only tool is a hammer all problems start to look like a nail?" What ties the bow atop this ugly package is the data regarding sales of spinal fusion equipment.
Aggregate sales in the United States amount to $5.
1 billion a year, nearly twice what the total sales are in the rest of the world, according to Millennium Research Group, who's findings support the theory that about one half of the surgeries being performed in the US are unnecessary and not medically required.
Indeed the study by Millennium Group came to that conclusion, and their findings have been corroborated by a recent Washington Post article from February of 2013.
While the Millennium study was not based on national data, but state level data, the conclusions posited are congruent with the larger picture painted by the available US national and international medical statistics on back pain and surgery.
In their Washington Post article, Dan Keating and Cristina Rivero analyzed hospital discharge data from 1992 to 2012 and published their results here.
Their conclusion was that half of spinal fusions were not performed for sound medical reasons.
After reading through their conclusions I was left to wonder why anyone would chose surgery over more natural (and cheaper) solutions.
Interestingly, while evaluating success rates of spinal surgery for this article, I was surprised to learn that there are two different methods for success rates to be determined.
While surgeons rate as successful any operation that went as planned without additional complications, patients are likely to evaluate surgery as successful by the effect it has on their pain.
By the surgeon's approach over 90% of back surgeries are effective.
But, for the patient who is hoping to reduce their pain level, surgeries are often ineffective in reducing pain, even when they are effective in improving structural integrity of the spine.
While statistics vary wildly due the subjective nature of how a patient might measure success, some sources report only a 30% effectiveness when surgery is judged by improvements in pain level as self-reported by the patients (not surgeons).
Often surgery is performed without a well developed medical case.
In these instances the success rate is much lower.
Why then is back surgery such a popular option in this country? Could it be that we have too many surgeons who are simply looking for a solution which affords them the opportunity to apply their skill set? I'm reminded of the old saying, "if your only tool is a hammer, every problem looks like a nail.
" But another reason could be that patients are often impatient to simply get the problem fixed (as though their health issue is someone else's problem and not their own).
They want the doctor to fix the back problem and fix it right away so that they can go on with their lives.
A more holistic approach could be just as effective.
If patients were indeed 'patient' enough and willing to try other avenues of treatment like rest and exercise that allow the body to heal itself.
(Timothy Johnson, MD.
ABC News,2006).
While I have experienced back pain a few times myself I have always sought more holistic, natural methods (yoga, massage and acupuncture) to handle it and with great success...
my back pain eventually went away.
But I had patience and didn't mind spending a few dollars of my own money to get massages and see an acupuncturist, methods that are not always covered by medical insurance.
But surgeries are covered, physicians visits, physical therapy and walkers, canes and crutches all covered.
Perhaps the growth in costs and the lack of concern for effective treatment is more a function of the insurance industry and it's steadily escalating costs than it is an indictment of medical equipment manufacturers, or, perhaps, it can be attributed to a little of both.
Besides, if everyone gets paid what concern is there over patient defined outcomes?
Having known people in the past who had surgery and who consequently experienced very little in the way of relief from their back pain I started to wonder at the efficacy of back surgery, in particular laminectomies.
What I leaned painted a clear picture of the confusion that patients likely feel when trying to decide on a course of action to heal their back pain.
Part of the confusion is caused by how success rates for surgeries of this type are determined.
While patients may consider a success any improvement in their pain level, surgeons have a different way of looking at it.
If you are convinced you need surgery but can't afford it or don't have coverage perhaps there are other less expensive and more holistic approaches you should look into.
While they may not be covered by insurance yoga therapy (be sure the teacher you pick is qualified) massage and acupuncture can and do work regardless of what medical professionals may say about alternative therapies.
Perhaps the medical community is not as honest with their statistics as they may seem...
and maybe their judgment could be clouded by economic decisions and not the quality of life of their patients.
In the past 20 years, the number of surgeries has skyrocketed and the cost per procedure has tripled.
If you live in the US you are five times more likely to be prescribed back surgery than if you lived in the UK, and 40% higher than any other country in the world! According to national data the rate of spinal fusions in the US is about 150 per 100,000.
In Australia close to 50 per 100,000; in Sweden about 40 per 100,000; and in Britain it is lower still, closer to 30 per 100,000.
Since the introduction of high tech gadgetry to the array of available medical equipment in the early 90's the number of surgeries has increased to 465,000 nationally in 2011 from only 56000 in 1994.
Surgical costs have, on average, gone from about $40,000 in 1992 to over $110,000 in 2012.
I think it is something of an economic anomaly that right after new technology was introduced to the marketplace (better and more expensive laminectomy equipment) the medical need suddenly tripled? Could this be a case of "if your only tool is a hammer all problems start to look like a nail?" What ties the bow atop this ugly package is the data regarding sales of spinal fusion equipment.
Aggregate sales in the United States amount to $5.
1 billion a year, nearly twice what the total sales are in the rest of the world, according to Millennium Research Group, who's findings support the theory that about one half of the surgeries being performed in the US are unnecessary and not medically required.
Indeed the study by Millennium Group came to that conclusion, and their findings have been corroborated by a recent Washington Post article from February of 2013.
While the Millennium study was not based on national data, but state level data, the conclusions posited are congruent with the larger picture painted by the available US national and international medical statistics on back pain and surgery.
In their Washington Post article, Dan Keating and Cristina Rivero analyzed hospital discharge data from 1992 to 2012 and published their results here.
Their conclusion was that half of spinal fusions were not performed for sound medical reasons.
After reading through their conclusions I was left to wonder why anyone would chose surgery over more natural (and cheaper) solutions.
Interestingly, while evaluating success rates of spinal surgery for this article, I was surprised to learn that there are two different methods for success rates to be determined.
While surgeons rate as successful any operation that went as planned without additional complications, patients are likely to evaluate surgery as successful by the effect it has on their pain.
By the surgeon's approach over 90% of back surgeries are effective.
But, for the patient who is hoping to reduce their pain level, surgeries are often ineffective in reducing pain, even when they are effective in improving structural integrity of the spine.
While statistics vary wildly due the subjective nature of how a patient might measure success, some sources report only a 30% effectiveness when surgery is judged by improvements in pain level as self-reported by the patients (not surgeons).
Often surgery is performed without a well developed medical case.
In these instances the success rate is much lower.
Why then is back surgery such a popular option in this country? Could it be that we have too many surgeons who are simply looking for a solution which affords them the opportunity to apply their skill set? I'm reminded of the old saying, "if your only tool is a hammer, every problem looks like a nail.
" But another reason could be that patients are often impatient to simply get the problem fixed (as though their health issue is someone else's problem and not their own).
They want the doctor to fix the back problem and fix it right away so that they can go on with their lives.
A more holistic approach could be just as effective.
If patients were indeed 'patient' enough and willing to try other avenues of treatment like rest and exercise that allow the body to heal itself.
(Timothy Johnson, MD.
ABC News,2006).
While I have experienced back pain a few times myself I have always sought more holistic, natural methods (yoga, massage and acupuncture) to handle it and with great success...
my back pain eventually went away.
But I had patience and didn't mind spending a few dollars of my own money to get massages and see an acupuncturist, methods that are not always covered by medical insurance.
But surgeries are covered, physicians visits, physical therapy and walkers, canes and crutches all covered.
Perhaps the growth in costs and the lack of concern for effective treatment is more a function of the insurance industry and it's steadily escalating costs than it is an indictment of medical equipment manufacturers, or, perhaps, it can be attributed to a little of both.
Besides, if everyone gets paid what concern is there over patient defined outcomes?
Source...