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A small sample of recent articles:

Bloomberg "Highest-paid US Doctors get Rich with Fusion Surgery Debunked by Studies" –December 30, 2010 bloomberg.com

Wall Street Journal "Top Spine Surgeons Reap Royalties, Medicare Bounty" – December 20, 2010 wsj.com

Wall Street Journal “Taking Double Cut, Surgeons Implant Their Own Devices” – October 8, 2011 wsj.com

National Public Radio "Surgery May Not Be the Answer to an Aching Back" – April 6, 2010 npr.org

Surgical Neurology "’Unnecessary" Spinal Surgery: A Prospective One Year Study of One Surgeon’s Experience" – 2011 Volume 2, Issue One

Dramatic Increases in
Spinal Surgeries
The number of spinal surgeries and fusions performed in the United States rose steadily throughout the 20th century, but since the early 1990s there has been a dramatic jump in spinal fusion surgeries. These include a 220% increase in lumbar fusions between 1990 and 2000 (Spine vol.30, no.12, pp 1441-45), and 2.4 fold increase in the annual number of spinal fusion hospital discharges between 1998 and 2008 (Rajaee, Bae, et al Spine 2012 vol.37, no.1, pp76-76).

Nearly 20% of spinal surgeries may be unnecessary

These figures do not even include the significant number outpatient spinal fusion procedures being performed. In a recent NPR interview, Richard Deyo, M.D., co-author of a recent JAMA article titled "Trends, Major Complications, and Changes Associated with Surgery for Lumbar Spinal Stenosis in Older Adults" (JAMA, April 7, 2010, vol.303 no. 13), stated "the most complex type of back surgery has increased dramatically between 2002 and 2007, with a 15-fold increase."

Reasons for this jump are multiple and include but are not limited to better instrumentation, ever-expanding indications and, not to be underestimated: the significant financial incentives attached to performing back surgeries. A recent article in Surgical Neurology by Nancy Epstein and Donald Hood from the Department of Neurological Surgery at the Albert Einstein College of Medicine regarding unnecessary spinal surgery concluded that over one year study period 17.2% of spinal surgeries recommended were unnecessary.

In the United States the rate of spinal surgeries and fusions has skyrocketed over the past 20 years, a phenomenon not witnessed in any other industrialized nation.

Significant risks. Spinal surgery and spinal fusion have many implications and risks. The typical risks of any surgery such as bleeding and infection are amplified by the nature of lengthy spinal surgeries with excessive blood loss and implantation of foreign bodies (i.e. hardware). In one study, 63% of patients required a blood transfusion when undergoing revision lumbar surgery. (Spine 2002, vol. 27, pp 818-824).

“You can’t unscramble an egg.”

As the complexity and invasiveness of spinal surgery has increased, operative times, blood loss, infection rates, and reoperation rates (failure) have also increased. Spinal fusion is not reversible. It is also theorized that spinal fusion leads to further deterioration of adjacent levels of the spine.

Over the past 20 years, the rate of spinal surgeries and fusions has skyrocketed in the United States, a phenomenon not occurring in any other industrialized nation. The accompanying increases in failures and complications is also alarming, including longer operative times, higher infection rates, higher blood loss, neurologic deficit, high reoperation rates, "failed back surgery syndrome", failed fusion, hardware failure, chronic pain...and the list the goes on and on.

Despite these results, and even as reimbursement-per-procedure to doctors has declined, the number of surgeries and fusions continues to rise.

Sorting out the risks and benefits. It can be a daunting challenge for patients to sort out the risks and benefits of spinal surgery. Of course there are the patients who do very well following spinal surgery. There are also many who don't, and many of those patients go on to live in chronic pain with limited treatment options. Additionally, the trend of people becoming addicted to narcotic pain medications following back surgery is well documented phenomenon.

Making the right decision. At Second Opine Spine we believe that anyone contemplating spinal surgery should obtain an independent second opinion. We believe in surgery only as a last resort. That is why we are here. Second Opine Spine will perform a comprehensive physical exam, review all your records and films, and give you a truly independent second opinion so that you can have the peace of mind of knowing that you made the right decision.


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