subject: Don't Get The Complicated Back Surgical Procedure When The Simple One Can Work [print this page] Nearly every week, I find out about a patient who had a surgical treatment to relieve horrible chronic back pain and wound up with worse symptoms than they had prior to surgery. Among the list of major problems is that money provokes surgeons to talk people into much greater and more intricate surgical procedures than they really need -- and then those surgical procedures cause expected complications.
The greed allegation sounds a bit harsh, but it comes straight from the top: The Journal of the American Medical Association, in an editorial by a leading Stanford orthopedic surgeon, Eugene Carragee, and in a study carried out by a group of medical doctors at Oregon Health and Science University led by Dr. Richard Deyo.
The Oregon research observed that the amount of complicated surgical treatments for back pain in Medicare patients went up by 15-fold over a recent five-year time period, but there was absolutely nothing in the individual population -- like increasingly complicated back deformities -- to justify the increase.
Surgical rates for uncomplicated decompressions are about $600 to $1,000. The complex surgeries generate surgical professionals as much as 10 times more. Another possible point to consider is the propensity for both physicians and people to go for a new, more pricey strategy simply because it sounds better.
The challenge is that the more elaborate surgical procedures have at least double the chance of a negative outcome, according to the analysis.
Almost all back pain that isn't relieved effectively with medicines or other non-surgical therapies is brought on by disk herniation or spinal stenosis. Spinal stenosis is growth of bone near a nerve travelling out of the spinal cord which pushes on the nerve root and causes ache to travel down a leg. The majority of patients who have to have back surgery because of spinal stenosis can be benefited from a rather simple lumbar decompression. This consists of removing bone, ligament and facet joint material which is compressing the nerve root. This operation has a high degree of success as it's been improved over the last 20 years.
As outlined by one editorial, if the individual also has some deformity of the spine -- front to back or side to side -- the simple lumbar decompression can bring about spine instability with greater deformity, so those patients might need a fusion where adjacent vertebrae are fixed together with bone grafts. Even in these circumstances, simpler approaches get just as good results than more elaborate treatments that add metal or other instrumentation into the back.
