C1 Blog

I found this great article by Robert Langreth in Forbes magazine which is published in the US. My concern is that what happens there floats over the sea and starts to happen here. To make it easier to digest I have pruned it a bit and it’s here, enjoy:

“Why You Should Never Get Fusion Surgery For Plain Back Pain
Jan. 10 2011
By ROBERT LANGRETH
A recent Bloomberg article should put the fear of God in anyone who wants to get a fusion operation for low back pain blamed on worn-out spinal discs…..This is one of the best indictments of this highly controversial and lucrative operation that has been growing like wildfire, despite multiple studies that say it is no better than a good physical therapy and exercise program (my underlining) –and a lot more dangerous.”

In the article he mentions that:

“..Another 125 patient study touted as having positive results for fusion is missing follow up data from a full 45 patients. In another study more than 5% of people who got complex fusion operations had life-threatening complications.”

And

“I’ll add another detail: the theory behind this operation is poor, as there is no surefire way to pinpoint the pain to the degenerated discs being operated on.”

He goes on to add:

“Another amazing fact: Even if the doctor performs the operation properly, you may still end up paralyzed from the waist down”

and then quotes a pretty horrible example of failed back surgery. The main point of this is that in most cases with bad results, proponents of the op can blame the doctors who performed it, saying they could have done it better. In his quoted case the surgeon was not to blame having carried out the op in a flawless manner – no, it was the op itself that was flawed.

His main thrust is that in the US the reason there is a huge surge in this operation is that both the surgeon and the implant manufacturer all gain from this op, and in the US, big time.
Studies that have looked at the expansion in these expensive back pain treatments have found no overall improvement in health. In 2009, two large studies found that another common back operation to treat pain from severe spinal osteoporosis was no better than a fake operation. Another op done for knee arthritis pain has been performed for years on thousands of patients before studies showed it did nothing more than a placebo operation.

And, so:

“In the absence of a rigorous placebo controlled trial there is simply no way to tell [if these are working]. Surgeons have all sorts of excuses for not doing these studies.”
Maybe they are afraid of what the results may reveal.

He adds that:

“Another great article in the Wall Street Journal found that some doctors who are performing the controversial fusion surgery like crazy just happen to be getting huge fees from Medtronic, maker of gear that is used in the operation. The article proves what everyone had always suspected, there is a huge correlation who is getting industry payments and how often the operation gets done:
Norton Hospital in Louisville, Ky., may not be a household name nationally. But five senior spine surgeons have helped put it on the map in at least one category: From 2004 to 2008, Norton performed the third-most spinal fusions on Medicare patients in the country.
The five surgeons are also among the largest recipients nationwide of payments from medical-device giant Medtronic Inc. In the first nine months of this year alone, the surgeons—Steven Glassman, Mitchell Campbell, John Johnson, John Dimar and Rolando Puno—received more than $7 million from the Fridley, Minn., company.”

The risk doesn’t appear to be worth the it especially given that a good rehab program gets you the same results with less cost and much less risk of side effects. In many cases, there are simpler, less-controversial operations such as spinal decompression that may help without the hideous fusion of vertebrae.

Caveat: There are real reasons to do the fusion operation for certain spinal abnormalities and deformities. But these non-controversial uses and there has not been a sudden outbreak of significant scoliosis that is driving the explosion in use of this dubious procedure.