Surgeons Ordering More Expensive and More Risky Spinal Surgeries

I have been in practice for 20 years. During that time, I have treated the elderly and the young. I have had my successes, and my failures. I am very proud of my record. I love my patients, and I care deeply about how they respond to my treatment.

I honestly believe that my medical physician colleagues are, for the most part, equally invested in their patients.

A recent JAMA article takes a close look at current trends in spinal surgical procedures ordered and performed on elderly patients with a condition known as Spinal Stenosis. The researches indicated that there are basically three kinds of surgeries performed for Spinal Stenosis. The first, called "decompression", refers to the removal of some of the bone in the spine in order to take pressure off of the spinal cord or nerve roots. According to the study, this procedure, of the three, presents the patient with the least amount of risk, and it is the least expensive at an approximate cost of $30,000.

The other two types of surgical procedures are spinal fusions. A simple fusion involves 1-2 disc levels, while a complex fusion involves more than 2 disc levels and requires a surgical approach from two angles. The fusion surgeries cost typically $60,000-$90,000 each.

Here is the scary part of this whole nasty business...

In the period of 2002-2007, the rate of spinal complex fusion procedures increased "15-fold, from 1.3-19.9 per 100,000 beneficiaries," while the rate of decompression surgeries declined. To make things worse, those that undergo complex spinal fusion surgeries experience life threatening complications more than twice as often as those that have spinal decompression surgery without fusion.

So, the more expensive and more invasive surgical procedure is on the rise, while the easier and less complicated and less expensive surgery is on the decline. Something smells... something smells bad.

An AP article was published today. According to a quote in this article, "aggressive marketing of devices used in complex fusions is likely playing a role in the increase." The article also states that "allegations of kickbacks to spine surgeons for using products and questionable financial arrangements to doctors as consultants have plagued the multibillion-dollar industry. One company, Medtronic Inc., reached a $40 million settlement with the U.S. Justice Department in a whistleblower case that included allegations the company paid doctors to use its spine surgery products. The company denied any wrongdoing."

The cost to Medicare for the three spinal surgeries combined is $1.65 billion per year. Try not to choke...

I treat many patients with spinal stenosis. It is a condition that does not get better, and gradually gets worse. I treat them with Chiropractic Adjustments ($30.00, as per Medicare), spinal traction, and simple therapies, like electrical stimulation and ultrasound. Some will respond to simple exercises (by the way, medicare will not pay for electrical stimulation, ultrasound, exercise therapy, or traction....) Although not all of them respond to my treatment, I have saved you, and me, the taxpayers, MILLIONS OF DOLLARS by preventing or eliminating, in some cases, the need for ANY spinal surgery. It is something that I am very proud of.

But the smell keeps getting worse... many of the patients that undergo spinal surgeries late in life never fully recover. They end up in nursing homes and under hospice care, where they continue to drain the coffers of Medicare.

So.... let me boil this all down to its lowest common denominator:

According to Medicare and spinal surgeons, $90,000 spinal surgeries are just fine. What makes them extra special is that they are probably not necessary most of the time, they cause more injuries than other less expensive procedures, they are more expensive (which obviously makes them of more value... right?), and they can lead to disability and dependency on the medicare system.

How about option #3? Chiropractic care: It is less expensive, has minimal or no side affects, and helps the patient to be more independent.

Please excuse my sarcasm. In reality, it ought to be enough to make us all cry... to cry out and wonder what is going on, Write your Senator and Congressmen. Ask them to expand chiropractic coverage and to include it in any health care reform legislation. It could save us all a ton of money.