News - Is costlier spinal surgery worth it?

[ANTHONY]

Is costlier spinal surgery worth it?

By Carla K. Johnson

Associated Press

CHICAGO - A study of Medicare patients shows that costlier, more complex spinal-fusion surgeries are on the rise - and sometimes done unnecessarily - for a common lower-back condition caused by aging and arthritis.

What's more alarming is that the findings suggest these more challenging operations are riskier, leading to more complications and even deaths.

"You have one kind of operation that could cost $20,000 and another that could cost $80,000, and there's not good evidence the expensive one is being used appropriately in the majority of cases," said Eugene Carragee of Stanford University Medical Center.

Add to that the expense for patients whose problems after surgery send them back to the hospital or to a nursing home, and "that's not a trivial amount of money" for Medicare, Carragee said. He wrote an accompanying editorial in the Journal of the American Medical Association, where the federally funded study appears Wednesday.

The cost to Medicare, just for the hospital charges for the three types of back surgery, is about $1.65 billion a year, the researchers say.

All the patients in the study had stenosis in their lower backs, a painful squeezing in the spine that is most common in people over 50. The researchers compared the risks for three types of surgery for the condition: decompression, simple fusion, and complex fusion.

"Some seem to be associated with higher complication rates than others," said lead author Richard Deyo of Oregon Health and Science University in Portland. "It's not necessarily true that the more aggressive surgery is better."

Patients should ask their doctors about alternatives to complicated operations, Deyo said: Could steroid injections and physical therapy be tried? Would a simple decompression procedure be as helpful as a spinal fusion and with less risk?

In a decompression procedure, the simplest method in the study, a surgeon cuts away part of the bone that is painfully pressing on nerves. It can cost about $30,000 in hospital and surgeon fees.

For a fusion, a surgeon binds two or more vertebrae together using a bone graft, with or without plates and screws. The researchers defined a complex fusion as one involving three or more vertebrae or more than one side of the spine. Fusions cost $60,000 to $90,000.

The researchers analyzed data on more than 32,000 Medicare patients who had one of the three surgeries in 2007.

About 5 in 100 patients who had simple or complex fusions suffered major complications such as stroke, compared with 2 in 100 with decompressions. The risk of death within 30 days after surgery was different, too: 6 in 1,000 for complex fusions, 5 in 1,000 for simple fusions, and 3 in 1,000 for decompressions.

[JeffreyD]

This type of conversation about spine care is about 20 years behind the rest of the world.....
-Jeff

[ANTHONY]

Thats incredible i didn't realize the medical field was that far behind.

[JeffreyD]

Not in every area, but most. It's a real eye opener when, like you, a person begins research into medical information from a world-wide point of view; just wanting to become educated as a patient.
We take our doctor's word as truth for so many things in the US, when in reality, in terms of healthcare, we are way behind many parts of the world.
I was shocked when I began my research many years ago.
-Jeff

[mmglobal]

Anthony, thanks for posting.

These types of discussions are interesting. It reminds me of the statistic that 70% of the people who are treated for mental illness recover AND 70% of the people who are not treated for mental illness recover. The numbers suggest that treating mental illness is pointless. I see similar studies with spine. In my mind, they drive home the point that if you need spine surgery, you are in trouble. However, none of the numbers speak to individual cases.

If you don't mind, I'll move this post from the surgical outcomes and blogs forum and give it a more descriptive title.

Thanks again for participating... all the best,

Mark

[Crystal33]

This paper is what greatly elevated my fears of spine surgery, taking also into account the huge costs and risks (ADR or fusion). The doctors involved appear to have excellent credentials.

"Copyright © 2007 by British Editorial Society of Bone and Joint Surgery

Survival and clinical outcome of SB Charité III disc replacement for back pain

R. Ross, MBChB, FRCS(Ed), FRACS, Spinal Surgeon1; A. H. Mirza, MBChB, MRCS(Ed), Spinal Fellow1; H. E. Norris, BA(Hons), RGN, Research Nurse1; and M. Khatri, MS(Orth), FRCS(Tr & Orth), Consultant Spinal & Orthopaedic Surgeon1

1 Salford Royal NHS Foundation Trust, Eccles Old Road, Salford, Manchester M6 8HD, UK.

Correspondence should be sent to Mr R. Ross; e-mail: ersross@hotmail.co.uk

Between January 1990 and December 2000 we carried out 226 SB Charité III disc replacements for lumbar disc degeneration in 160 patients. They were reviewed at a mean follow-up of 79 months (31 to 161) to determine the clinical and radiological outcome. The clinical results were collected by an independent observer, who was not involved in patient selection, treatment or follow-up, using a combination of outcome measures, including the Oswestry Disability Index. Pain was recorded using a visual analogue score, and the most recent radiographs were reviewed.

Survival of the device was analysed by the Kaplan-Meier method and showed a cumulative survival of 35% at 156 months when radiological failure was taken as the endpoint. The mean improvement in the Oswestry disability index scores after disc replacement was 14% (6% to 21%) and the mean improvement in the pain score was 1.6 (0.46 to 2.73), both falling below the clinically significant threshold. Removal of the implant was required in 12 patients, four because of implant failure.

These poor results indicate that further use of this implant is not justified."

[ANTHONY]

Hi Mark
I Understand.I'd like to talk to you sometime.

[Crystal33]

Maybe the high level of poor long term results from existing ADR technology (above) may be largely resolved in future with introduction of new generation of bio design ADR's such as M6. I hope so.
November 4, 2009....."Stenum Hospital announced the successful rollout of the first international patients to receive the Spinal Kinetics M6-L artificial lumbar disc, and the commencement of the implants full availability at the clinic. Four American patients received M6-L implants, one single level, two double level, and one three level intervention, 8 total implants. All patients are doing well."

[ANTHONY]

Hi Crystal
I'm pleased to read something positive. I just wish we lived in Germany.

[sahuaro]

I think some background and perspective--including political--are needed here.
Dr. Deyo is trained in internal medicine--not neurology, not neurosurgery, not orthopedic spine surgery. He has waged a campaign against spine surgery for years and has worked with managed care panels to "study" the cost of spinal surgery. That doesn't mean necessarily that he doesn't make some good points, but as we all know, the aim of HMO's is to save money by denying treatment (to put it bluntly). I am very frightened by his now saying that Medicare is wasting money by covering spine surgeries and see this as the beginning of restricted health care under the new health plan.

BTW, I am doing very well with my Prestige-ST ADR and am very grateful for the surgery--for which we had to pay out of pocket.

[Crystal33]

Sadly, it is a dollar driven world. Medical and big pharma industries are extremely dollar driven. Harsh laws are needed (imo) to ensure that patients cannot be led into unnecessary or unwarranted procedures due to profit motives of others.

"The incentives are such that if there is no difference in risk to patients and people are faced with alternatives that profit them a little or a lot, a certain number of people will choose a lot," said Dr. Eugene J. Carragee, professor of orthopedic surgery at Stanford University School of Medicine, who wrote an accompanying editorial. "It appears that the bigger operations are being done more than the pathology necessarily warrants."

The severity of spinal stenosis has not increased over the past few years, Carragee said. "Without much change in the disease itself, the kind of operations that are being done are increasingly dangerous," he said.

The findings should remind patients and surgeons to carefully assess the risks and benefits of various back procedures, he wrote.

A provision in the recently approved U.S. health care bill provides for studies of alternative procedures for safety and effectiveness, which could change current practice, Carragee said. But it will take years for such studies to be conducted on surgery for back pain, he noted.

SOURCES: Richard A. Deyo, M.D., M.P.H., the Kaiser Permanente-Endowed Professor of Evidence-Based Medicine, Department of Family Medicine, Oregon Health and Science University , Portland, Ore.; Eugene J. Carragee, M.D., professor, orthopedic surgery, and chief, spine surgery center, Stanford University, Stanford, Calif.; April 7, 2010, Journal of the American Medical Association"