According to a study of Medicare patients, more complex and expensive spinal fusion surgeries are increasing. Sometimes they are even performed unnecessarily for common lower back conditions that are the result of aging and arthritis.
The scary part is that these challenging operations are riskier and can lead to even more complications and sometimes even death.
The researchers claim that the cost to Medicare, for the hospital charges on the three types of back surgery reviewed, is around $1.65 billion annually.
In the study, all of the patients had a condition called stenosis in their lower back. This is a painful squeezing in the spine that is common in people over 50. Three different types of surgery for the condition were compared by the researchers: simple fusion, decompression and complex fusion.
Dr. Richard Deyo of Oregon Health and Science University in Portland said, “It’s not necessarily true that the more aggressive surgery is better, at least in terms of safety.” There is currently not much agreement when it comes to the best way of treating chronic lower back pain. A lot of it depends on exactly what is causing the pain.
Deyo said that before considering surgery, patients should ask their doctors about other avenues to complicated operations. Perhaps steroid injections or physical therapy could be tried first. Maybe even a simple decompression procedure could be as effective as a spinal fusion and with less risk.
A decompression procedure is the simplest method in the Medicare study. In this procedure, a surgeon cuts away part of the bone that is pressing painfully on the nerves. It can run around $30,000 in hospital and surgeon fees.
During a fusion, a surgeon secures two or more vertebrae together using a bone graft, sometimes using plates and screws. A complex fusion, as defined by the researchers, involves three or more vertebrae or more than one side of the spine. Fusions can cost $60,000 to $90,000.
Data, from more than 32,000 Medicare patients who had one of the three types of surgeries in 2007, was reviewed by the researchers. It was found that a complex fusion was performed on more than half of the patients who only had a simple stenosis condition. Usually this condition calls for just decompression only. They did not have curvature of the spine or a slipped vertebra, which are specific conditions that suggest a fusion might be necessary.