Beware the Surgeon Selling Spinal Fusion

Spinal fusion, a type of surgery in which the vertebra of the spine are locked together using rods and screws, is a popular surgery promoted by some orthopedists for everything from bulging disks to "weak or unstable" spines (whatever that really means). The trouble is, spinal fusion...umm...doesn't really work better than the alternatives (the safest of which is chiropractic care, by the way). Failure is common and risks are high. So why is it being performed?

Well, according to a study published this month in the Journal of the AMA, the answer is: It makes money. That's right, increasingly useless (and dangerous) surgeries are being performed purely for profit.

The writers at ChiroACCESS put it this way:

There is a lack of evidence-based support for the efficacy of complex fusion surgeries over conservative surgical decompression for elderly stenosis patients.  There is, however, a significant financial incentive to both hospitals and surgeons to perform the complex fusions.  Spinal stenosis is the most frequent cause for spinal surgery in the elderly.  There has been a slight decrease in these surgeries between 2002 and 2007.  However, there has also been an overall 15 fold increase in the more complex spinal fusions (360 degree spine fusions).  Deyo et. al. in yesterday’s issue (April 7, 2010) of the Journal of the American Medical Association concludes that  “It is unclear why more complex operations are increasing. It seems implausible that the number of patients with the most complex spinal pathology increased 15-fold in just 6 years.  The introduction and marketing of new surgical devices and the influence of key opinion leaders may stimulate more invasive surgery, even in the absence of new indications…financial incentives to hospitals and surgeons for more complex procedures may play a role…”  There is a significant difference in mean hospital costs for simple decompression versus complex surgical fusion.  The cost of decompression is $23,724 compared to an average of $80,888 for complex fusion.  Despite the much higher cost, there is no evidence of superior outcomes and there is greater morbidity associated with the complex fusion.  The surgeon is typically reimbursed only $600 to $800 for simple decompression and approximately ten times more, $6,000 to $8,000 for the complex fusion.

So if anyone suggests to you that you need spinal fusion surgery, first get a proper assessment of your condition by a chiropractic physician.

In some cases, surgery may be required. But the research is clear: Rarely is spinal fusion an appropriate option.