Back Surgery is Controversial
Written by Editor   
Friday, April 25, 2014 09:51 AM

CBS News reports that "Back pain is one of the most common reasons Americans go to the doctor, and one of the fastest growing treatments is spinal fusion surgery. From 2001 to 2011, the number of spinal fusions in U.S. hospitals increased 70 percent, making them more frequently performed than even hip replacements."

"The procedure fuses together two or more vertebrae often with metal rods and screws, and can result in paralysis or life-threatening complications."

While improving technology and an aging population makes the ability to perform the surgery easier "it has also sparked a debate over whether some surgeons are performing spinal fusions that are unnecessary and potentially dangerous."

For this six month investigation, CBS News exclusively obtained part of a government database. "We asked for, among other things," CBS News reports, "the number of spinal fusions each doctor in the country billed to Medicare from 2011-2012, under codes most commonly used for "degenerative" conditions that cause lower back pain. We put the entire database online and made it easily searchable by the public. We also provided guidance on how to interpret it and details about how it was compiled. 

We looked into some of the highest volume surgeons and found some were respected with unblemished records. Others were banned or suspended from hospitals or settled lawsuits alleging unnecessary procedures. All of them are still operating.  The data shows that a small group of doctors performed these procedures far more frequently than their peers. While the national average was 46 surgeries over the two year period, some did more than 460. While the average spine surgeon performed them on 7 percent of patients they saw, some did so on 35 percent.

There is also a financial incentive to performing a spinal fusion. It can earn a surgeon thousands of dollars - and five times as much as less risky alternatives. Some of the biggest concerns surround more complex fusions that join four or more vertebrae. One study of complex fusions for stenosis (a narrowing of the spinal canal) found 1 in 20 led to life-threatening complications.  The more vertebrae that a surgeon fuses, the more they are paid.

Medicare, medical societies, and credentialing boards should use data like this to follow practice patterns and patient outcomes.  "Surgeons with the highest numbers should be looked at closely and asked to explain themselves," the report notes.