Why You Should Never Get Fusion Surgery For Plain Back Pain
by Robert Langreth
A recent Bloomberg article should put the fear of God in anyone who wants to get a fusion operation for low back pain blamed on worn-out spinal discs. I've written about the lack of evidence behind surgery for pain for years. This is one of the best indictments of this highly controversial and lucrative operation that has been growing like wildfire, despite multiple studies that say it is no better than a good physical therapy and exercise program, and a lot more dangerous.
The article has several great examples of what can happen when the operation goes wrong. It somehow manages to put much of the best stuff at the end, so I will summarize some it for you. There is one patient in the story who was still in such pain after the operation he ended up dying of a painkiller overdose at age 41. Another 125 patient study touted as having positive results for fusion is missing followup data from a full 45 patients. In another study more than 5% of people who got complex fusion operations had life-threatening complications. I'll add another detail: the theory behind this operation is poor, as there is no surefire way to pinpoint the pain to the degenerated discs being operated on.
Another amazing fact: Even if the doctor performs the operation properly, you may still end up paralyzed from the waist down:
<<In 2004, [Minnesota surgeon Manuel] Pinto was seeing Jean Kingsley, 57, a patient who had had two previous fusion surgeries and was still suffering back pain. Pinto told her, according to a hospital report he wrote, that more "surgical treatment could provide her with some relief of her pain" if her symptoms "were extremely severe, unrelenting" and had "failed extensive conservative care," which "appeared to be the case.">>
<<Her third operation, a daylong procedure by Pinto in September of that year, fused 13 vertebrae along her entire spine and was a disaster. Kingsley, of Milaca, Minnesota, returned home paralyzed from the waist down, according to hospital records in a lawsuit she brought against Pinto. A jury in Minnesota state court found earlier this year that Pinto was not negligent in the case.>>
(from the article "Surgeons Get Rich with Fusion Surgery Debunked By Studies" from Bloomberg, in our list of readings)
This example comes way down in the story. I suppose they thought it wasn't such a good example because the jury exonerated the doc. But this proves the point even more about what a lousy operation this is.
In most cases with bad results, proponents of an operation can blame the doctors who performed it, saying they would have done it better. In this case, the surgeon was not to blame, according to a jury ruling, and yet the patient still ends up paralyzed! In other words, the operation itself was to blame. (Caveat: There are real reasons to do the fusion operation for certain spinal abnormalities and deformities. But these non-controversial uses are not what is driving the explosion in use.)
So if this operation is so mediocre why is it all of sudden being done so often? Hint: the surgeons that do it get rich and so do the medical device companies that make gear for the operation. The doctor who did the operation right but the patient still was paralyzed lives in a 7000 square foot, $4 million home, according to the article. Studies that have looked at the boom in expensive back pain treatments find no overall improvement in health.
I have no doubt that doctors who do it are believers in the operation. It is pretty amazing how people can deceive themselves when they are making huge amounts of money and when the outcomes are totally subjective such as reported pain relief weeks and weeks later after the patient has finally recovered from the operation and tapered down on the heavy painkillers.
How do these surgeons know the pain relief has anything to do with the surgery itself? Maybe the patient would have started to feel better anyway, maybe it is the painkillers or rehab, or maybe it is all a big placebo effect. In the absence of a rigorous placebo controlled trial there is simply no way to tell. Surgeons have all sorts of excuses for not doing these studies. Maybe they are afraid of the what results will show. In 2009, two big studies shocked doctors by finding another common back operation to treat pain from severe spinal osteoporosis to be no better than a fake operation. Another knee operation for arthritis pain was performed for years and years on many of thousands of patients before studies showed it did nothing more than a placebo.
Here's another reason not to get fusion for low back pain: Your doctor may be totally biased because he is getting big payments from medical equipment makers. Another great article in the Wall Street Journal found that some doctors who are performing the controversial fusion surgery like crazy just happen to be getting huge fees from Medtronic, maker of gear that is used in the operation. The article proves what everyone had always suspected, there is a huge correlation who is getting industry payments and how often the operation gets done:
<<Norton Hospital in Louisville, Ky., may not be a household name nationally. But five senior spine surgeons have helped put it on the map in at least one category: From 2004 to 2008, Norton performed the third-most spinal fusions on Medicare patients in the country.>>
<<The five surgeons are also among the largest recipients nationwide of payments from medical device giant Medtronic Inc. In the first nine months of this year alone, the surgeons (Steven Glassman, Mitchell Campbell, John Johnson, John Dimar and Rolando Puno) received more than $7 million from the Fridley, Minn., company.>>
(from the article "Top Spine Surgeons Reap Royalties" from WSJ, in our list of readings)
I’m probably going to get e-mails from people who say they had successful fusions for low back pain. I don't deny there are some people like this out there. But the risk doesn't appear to be worth it, given that good rehab program gets you the same results with less cost and much less risk of side effects. In some cases, there are simpler, less controversial operations such as spinal decompression that may help without the fusion of vertebrae.
So, if you've read this post and are convinced that you need the operation, go get it. But please pay for it yourself if you get any complications.
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