Spinal Surgery Varies by Region in U.S.

“Nearly 80% of Americans will experience low back pain at some point in their lives, and about 30 million people a year receive professional medical care for a spine problem,” co-author Brook Martin, of the Dartmouth Institute of Health Policy & Clinical Practice, said in a college news release.

In spinal stenosis, thickening of tissue surrounding the spine affects the spinal nerves, resulting in pain, according to background information in the study. Treatments include surgery, medication, physical therapy and steroid injections, the study said.

The two types of surgery of surgery for spinal stenosis are spinal decompression and spinal fusion. In spinal decompression, doctors remove the tissue compressing the spinal nerves. In spinal fusion, surgeons join two or more vertebrae to stabilize the spine.

Spinal fusion has a higher risk of infection and readmission to the hospital, and there is no evidence that it provides greater benefit to patients, according to the news release. Even so, its use increased 67% among Medicare patients from 2001 to 2011 and it’s now more common than spinal decompression, the researchers said.

The study’s analysis of Medicare data revealed that rates of spinal decompression varied eightfold across the United States, from about 25 procedures per 100,000 patients in Bronx, N.Y., to nearly 217 procedures per 100,000 patients in Mason City, Iowa. In general, rates of spinal decompression were higher in the Pacific Northwest and northern Mountain states.



Rates of spinal fusion varied more that 14-fold nationally, from about 9 procedures per 100,000 patients in Bangor Maine, to about 127 procedures per 100,000 patients in Bradenton, FL, according to the Dartmouth Atlas Project report.

“It is critical that we fully inform patients of the risks as well as potential benefits through a collaborative process between patients and physicians of shared decision making,” Martin said. “Surgery is irreversible,” he added.

MY TAKE:
the last quote says it all “surgery is irreversible”. I am sure that the Medicare reimbursement rates for spinal fusion are much higher than those for decompression lamenectomy.

The fusion is a much more complicated procedure that involves harvesting bone from the hip to create the fusion or the use of metal implants. I have even seen ribs grafted to the sides of vertebrae to form a fusion.

Decompression involves removing the back of the vertebra (the lamina), taking the pressure off the spinal cord, and leaving the rest of the structure intact. It is far less invasive and generally has a better result.

I have seen many Failed Low Back Surgery Syndrome patients in my office. Fusions comprise a vast majority of those cases. Furthermore, the fusion really limits the benefits I might provide. I can treat the inflammation and reduce firing of the injury reflexes. Manipulation can usually be performed above and below the fusion site, but treatment at the site of injury is minimal.

THE BOTTOM LINE:
Pain is not a criterion for low back surgery. Only loss of function (muscle atrophy, neuropathy, and loss of bowel /urinary control) warrants surgical intervention. Furthermore, if you are of Medicare age and contemplating surgery, please explore the option of decompression lamenectomy rather than spinal fusion.

Source: National Institutes of Health -October 31, 2014