The rate of spine surgery performed in the U.S. has soared over the past decade. With surgeons and reputable websites reporting success rates of 95% or more, it’s no wonder that so many people go under the knife for back pain treatment.
But negative attention has recently been given to this high rate of surgery in the past few years, with questions concerning kickbacks for surgeons from surgical hardware companies and inflated success rates. It’s not uncommon for surgeons to judge the success of a spinal fusion procedure, for example, by how successful the fusing of vertebrae and not its effectiveness at resolving the patient’s pain.
Consumer Reports conducted a survey to see what patients had to say about the surgical procedures they received. If success rates were determined by patient satisfaction, the results showed that spinal fusion would have a success rate of around 56%, a far cry from 95%.
The Consumer Reports survey can be viewed at www.consumerreports.org. It brings to light the need for more patient information when deciding on spinal surgery and can help us determine what types of questions to ask before agreeing to surgery.
Questions for the Surgeon
1. What are the alternatives? Has every alternative been tried? Unless you have severe neurological symptoms and can’t function, surgery shouldn’t be the initial prescription. Many people are interested in pursuing chiropractic, physical therapy, traction, decompression treatments or movement therapies like yoga before even considering an invasive procedure. See if your doctor is open to these alternatives.
2. What are alternative surgical procedures? There are many types of spine surgery – laminectomy, discectomy, microdiscectomy – which have higher success rates, according to the Consumer Reports survey, than spinal fusion. Find out if a less invasive or more successful surgery is available.
3. What are all the risks of surgery? You need this information to weigh the possible pros and cons.
4. What could happen if you don’t have the procedure? If permanent nerve damage or debilitating pain is likely, this may make the decision more clear. If not, you may want to put off surgery.
5. Ask the surgeon if he or she has any idea of how past patients with your condition who forewent surgery have fared compared to those who went ahead with surgery. This information can help you determine how necessary the procedure is in general.
6. How long is the recovery time, and what rehabilitative treatments will it involve? This will both help you get a sense of the real time and money the treatment involves.
7. How many similar procedures has your surgeon performed, and what if any complications have resulted?
8. What treatment options are open to you if surgery fails to resolve your pain? Failed back surgery syndrome is more common than most statistics convey. It’s important to have a “plan B” in the worst case scenario that surgery fails.
9. It’s a good idea to get a sense of your surgeon’s incentives for performing surgery. Many surgeons receive kickbacks from surgical device companies, and this conflict of interest can lead to performing unnecessary surgeries. You may not be comfortable asking your surgeon what type of kickbacks he or she receives for performing procedures. Unfortunately, there is little to no transparency on this issue currently. Beginning in September of 2014, though, a public database will be available that shows which medical professionals have financial incentives for prescribing surgeries and drugs. See more on this at www.propublica.org.