If there was an Olympic event for back surgery, then the United States would be a gold medalist year in and year out. The United States is not only number one in the world in back surgeries performed annually, but it is also number one in the world in failed back surgeries annually. More than 20,000 lumbar spinal fusions are performed annually in this country. There are eight times as many spinal surgical procedures are carried out in the United States per capita as in Britain. Either the United States just coincidentally happens to have a lot of bad backs, or there are a lot of surgeries being performed needlessly.

There is also a direct relationship between the number of spinal operations performed in any one geographical area and the number of orthopaedic and neurosurgeons in that area. That being the case, the likelihood of you having surgery prescribed for you is related more to the demographics of your locale than it is to "getting the patient better".

Lumbar spinal fusion is costly – from an economic standpoint, and from a societal one as well. This is a consumer issue with some staggering numbers and facts.

The cost of a spinal fusion has a price tag of around $45,000. With 20,000 being performed annually, you are now looking at a total of $900,000,000 in surgeries alone. As for failed spinal surgeries, the numbers are staggering as well - a cost of $2 billion per year. That is a lot of money being spent on surgeries that are either unnecessary or that have failed.

As is the case for many medical conditions, the scientific literature does not support the value of lumbar spinal fusion. In a study by Chou et al (2009), it was reported that spinal fusion is no more effective than intensive rehabilitation, but it is associated with “small to moderate benefits compared to standard non-surgical therapy”. In a study from the British Medical Journal in 1996, Wilson-MacDonald stated that "The case for spinal fusion is unproved".

So how does the consumer know what to do? Who is telling the truth? Who do I trust – the doctor or the science?

There are three readily accepted reasons for performing a spinal fusion that are consistent in the scientific literature and current clinical guidelines: intractable pain (failing conservative treatment), worsening neurological symptoms in the lower extremity, and bowel or bladder symptoms. Yes, health care providers do come across patients that fit the bill here – though not nearly as frequently as the annual spinal fusion statistics might indicate. In today’s world, if you have back pain, and only back pain, the scientific literature would indicate that you should rarely (if ever) be left with surgery as your only option, let alone spinal fusion.

Sadly, many surgeons go right to spinal surgery and refuse to provide the patient with conservative treatment options. Worse yet, when one surgery fails, they are often offering up surgery number two, or three, or four, to “correct” the previous failed back surgery.

Does this require a frank discussion with your physician? Yes. But buyer beware as always. When the number of lumbar spinal fusions per capita is so incredibly high, you have to truly wonder if that is reflective of this nations’ lousy spines, or of the economic benefits of performing this costly procedure.

References:

Chou R, Baisden J, Carragee EJ, Resnick DK, Shaffer WO, Loeser JD. Surgery for low back pain: a review of the evidence for an American Pain Society Clinical Practice Guideline. Spine 2009; 34(10): 1094.

Wilson-MacDonald J. Should backache be treated with spinal fusion? The case for spinal fusion is unproved. BMJ 1996; 312(7022): 39-40.

Photo credits: planetc1