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Playing Football
Before Robert Gumatz, 60, had a five-level spinal fusion by Dykes in November 2009, the grain-company manager had so much back and hip pain he was losing the use of his legs, he said. He had stopped playing soccer with his kids and taking nightly walks with his wife. A year later, “I can play tackle football if I want to,” said Gumatz, of Oakdale, Minnesota. “I know I’m an exception. I have no pain.”
For 50 years, surgery was a calling at Twin Cities Spine. Led by surgeon John H. Moe, a pioneer in correcting scoliosis, or abnormally curved spines, the group’s doctors rebuilt the twisted backs of
children with polio and other malformations -- vertebra by vertebra.
They traveled at least 90 days a year, often paying their own way, to show doctors around the world how to mend childhood spinal deformities, said David Bradford, who spent 20 years at the practice before becoming chair of orthopedics at the University of California at San Francisco in 1991.
Adapting Fusion
At home, Bradford said surgeons operated weekly at Gillette Children’s Hospital in St. Paul, Minnesota, usually for free. “‘It was just what you did; that’s why we became doctors,” said Bradford, now a professor and chair emeritus at UCSF’s spine center. “We weren’t in medicine to make gazillions.”
While senior surgeons continue to research and treat crippling disease, Pinto and other protégés have also adapted the fusion techniques Moe pioneered to surgery for common back pain, said Robert Winter, the firm’s research director.
Twin Cities Spine surgeons published articles on fusion techniques for back pain and presented results at professional meetings. Its financial relationship with Medtronic, the largest maker of spinal implants in the U.S., began as early as 2002, when, according to a deposition by Pinto, he began receiving money from the company, which is based in Fridley, Minnesota.
Medtronic Money
In addition to the $1.75 million it paid the six Twin Cities Spine surgeons this year, Medtronic and three other device companies give the practice a total of $100,000 to $500,000 for a fellowship program, Arrington said. Twin Cities Spine calls it the largest such program in the country and says it has trained 140 spine surgeons.
Medtronic also has disclosed contributing $150,000 in 2008 to a non-profit that Schwender heads to spread the use of minimally invasive surgical devices. The contribution represented 95 percent of the non-profit’s expenses that year, according to the organization’s latest-available tax filings.
In 2004, Pinto was seeing Jean Kingsley, 57, a patient who had had two previous fusion surgeries and was still suffering back pain. Pinto told her, according to a hospital report he wrote, that more “surgical treatment could provide her with some relief of her pain” if her symptoms “were extremely severe, unrelenting” and had “failed extensive conservative care,” which “appeared to be the case.”
Not Negligent
Her third operation, a daylong procedure by Pinto in September of that year, fused 13 vertebrae along her entire spine and was a disaster. Kingsley, of Milaca, Minnesota, returned home paralyzed from the waist down, according to hospital records in a lawsuit she brought against Pinto. A jury in Minnesota state court found earlier this year that Pinto was not negligent in the case.
The judge awarded $46,616 in attorney’s fees to Pinto, which Kingsley said she can’t pay. She has appealed the decision. Her case is a “unique set of events for which even in retrospect there is no obvious explanation that one can prove,” Pinto said in his 2008 deposition, in which he estimated he performed 400 to 500 back surgeries a year.
Abbott and Twin Cities Spine billed a combined $239,000 for the surgery, Kingsley’s records show. Insurer Medica says it paid about a third of that amount after a discount.
Kingsley arrived home in a wheelchair, wore a diaper for two and a half years and had a home health aide visiting to bathe her in bed, she said in a deposition in the case. As her condition improved, she said she was able to move short distances with the aid of leg braces and a walker.
‘I’m Paralyzed’
Today, Kingsley lives alone after the 2008 death of her husband. She said she takes medication for depression and doesn’t do “much of anything,” usually watching television and reading, and lives off Social Security benefits from her husband’s death. “Now I don’t feel any pain,” Kingsley said in an interview. “I’m paralyzed.”
Pinto co-authored a study in Spine in 2009 on 125 of his patients who had, like Kingsley, undergone fusions of four or more vertebrae. The study, which a Twin Cities Spine fellow presented at six surgical conferences around the globe, concluded that patients with extensive degenerative pain “can be successfully treated with surgical intervention.”
The Pinto study showed why back-pain patients should avoid spinal fusions, said Stanford University’s Carragee. The paper tracked progress in only 80 of the 125 surgical patients; “what happened to the other 45 patients?” Carragee asked.
Lifting a Keg
Twenty-seven of the 80 patients needed a second surgery, while about 40 percent of the patients had complications, including 5 percent of the men who suffered permanently diminished sexual function, Carragee said.
“This should make you pretty cautious about doing this kind of stuff,” he said.
Twin Cities Spine, in its statement, said Pinto’s study was the first to report on such extensive fusion surgery for degenerative back pain, an operation it said “is in no way comparable” to less complicated procedures.
Schwender first performed fusion surgery on Catherine Engels in May 2001, after finding she had a herniated disc. She came to see him again on June 4, 2003, complaining of sharp back pain, her medical records show.
Engels, now 50, received Schwender’s support for a workers’ compensation claim, in which she said she injured her back lifting a keg at a liquor store where she worked in July 2000. Schwender said in a deposition that the incident was “a significant contributing factor” to Engels’s back problems.
‘Constant, Sharp Pain’
The workers’ compensation judge rejected her claim, finding “multiple significant inconsistencies” between her and Schwender’s testimony, on one side, and the medical records submitted by six doctors Engels saw before Schwender, on the other. Two of those doctors said Engels hadn’t attributed her back pain to any specific injury, and others said Engels attributed the pain to lifting patio brick, the judge found.
Schwender operated a second time on Engels in January 2004, removing the screws and rods he’d put in her spine and decompressing the spinal canal. It didn’t help. By then, Schwender told Engels, the rods and screws had shifted and caused permanent nerve damage, she said in an interview. Now she has “constant, sharp pain” down her left leg, treated with drugs and a neurostimulator in her back designed to send out current that interferes with pain signals.
“I went through with fusion thinking it would be the cure- all,” Engels said. “It wasn’t.”
OxyContin, Hydrocodone, Elavil
Dan Bebault was suffering from lower back and leg pain when he visited Twin Cities Spine’s Garvey in May 2006. Garvey discussed surgery with him and told him he’d “likely” be able to return to light work three to six months afterwards, according to Bebault and notes Garvey made on the case. “He pretty much talked me into it,” Bebault said.
The fusion took place in August that year. When Bebault returned to see Garvey five months later, he said, his life was falling apart. The pain had spread to his neck and arms, and OxyContin, hydrocodone and Elavil weren’t helping much. Bebault’s wife had left him after the surgery; he hadn’t worked in four years.
Garvey wasn’t sympathetic, said Bebault, a 53-year-old former machinist who lives in Brooklyn Park, Minnesota. “He said my life was like an old country-western song and he didn’t want to hear about it,” Bebault said in an interview at his home. “He said come back if I want more surgery.”
Methadone Overdose
Additional fusion surgery for Bebault’s neck “would be an option,” Garvey’s chart notes from this time say. Bebault, now reunited with his wife and on Social Security disability, decided against more surgery and quells the pain in his back and neck with 120 milligrams a day of morphine, plus occasional vicodin, valium and amitriptyline, an anti-depressant.
He said he feels “withdrawals” when his morphine wears off, shaking and sweating. His surgery cost his former employer’s workers’ compensation insurer $48,633; Garvey’s fee was $5,870.
“The patient is like a piece of meat; everybody’s making money off the guy,” Bebault said.
Garvey did a three-level spinal fusion on Ross Tamminen in April 2006. Six months later, Tamminen, a heavy-equipment operator, reported severe pain again in his back and legs, according to documents from a case in state workers’ comp court.
As a treatment option, Garvey proposed more surgery to examine the fusion site, remove the implants in Tamminen’s spine, and perform decompression. His employer’s insurer denied a coverage request, saying surgery wasn’t warranted, according to court filings.
The rest of the story comes from Tamminen’s mother, Barbara Grove. Denied federal disability benefits and in intractable pain, Tamminen ran out of money for painkillers, she said, and began taking methadone obtained through friends.
He died of an overdose on June 20, 2008, 26 months after spinal fusion. He was 41.
There you have it folks, a spinal fusion is a roll of the dice. It is not just that the surgeons doing them are greedy hacks, it's a bad procedure.