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View Full Version : Are spinal fusions wasted money?



JulieBW
03-11-2010, 11:28 AM
at least 351,000 spinal fusions were performed in 2007, reports the Agency for Healthcare Research and Quality, at a cost of $26.2 billion. Yet except in the tiny fraction of cases in which the pain is caused by fracture or tumor, they're uselessóbut financially irresistible, points out Shannon Brownlee in her 2007 book Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer. At $75,000 per spinal-fusion procedure, medical-device makers, hospitals, and surgeons have every reason to keep the gravy train rolling. "We doctors are extremely good at rationalizing," says Brody. "Somehow we manage to figure out how the very best care just happens to be the care that brings us the most money."

This quote is from this article in Newsweek
http://www.newsweek.com/id/234514

tonibunny
03-11-2010, 02:02 PM
This probably refers to the vast majority of spinal fusions, which are done to remove damaged discs and fuse that level rather than the spinal fusions that are done for deformity correction. Research has shown that for people with such problems, conservative techniques are often just as effective.

JulieBW
03-11-2010, 05:06 PM
Thanks! I wondered if they were just referring to low back pain situations, but the article did not say that at all.

txmarinemom
03-11-2010, 10:37 PM
Thanks! I wondered if they were just referring to low back pain situations, but the article did not say that at all.

They're just as like referring to cervical plating- which also has mixed results.

Gryffindor
03-27-2010, 10:29 AM
I also think the article includes those individuals who did not have the surgery due to scoliosis.

If it weren't benefiting those with scoliosis then why would the Shriners Hospitals perform the surgery?

RitaR
03-27-2010, 10:39 AM
And, for those of us with a 95 degree curve, what choice do we have. Our lungs and heart are getting squished and even bothering us eating with the tummy, so I don't feel we had much of a choice.

Pooka1
03-27-2010, 10:43 AM
Edited to say this analysis I previously wrote is completely wrong... I'll work on it and re-post.

More coffee please.

Pooka1
03-27-2010, 10:43 AM
And, for those of us with a 95 degree curve, what choice do we have. Our lungs and heart are getting squished and even bothering us eating with the tummy, so I don't feel we had much of a choice.

Neither did either of my kids have a choice.

The decision was easy for us... no choice.

titaniumed
03-27-2010, 12:07 PM
There are approx 300,000,000 people in the US. 30million would be 10%, 3 million would be 1%, 300,000 would be .1%. 351,000 would be .15%

If the amount of scolis is 2-3%, then that means that there are 6-9 million scolis in the US. Where the heck is everybody????

I know many non-scolis with 1 or 2 levels fused, and they are in a world of hurt. I just donít understand what the problem is. They look at my rack in dis-belief. I think it has to do with the extensive training that scoliosis surgeons go through. Mine did 19 years, AND they continue training....

Itís a shame that these fusions are considered "useless" If this continues, then something should be done as far as training is concerned. Should there be constant improvement? The rest of us are required to do this through ISO-9000. Its part of ISO protocol.
I donít understand why these things are happening???? In manufacturing today, we are expected to achieve 100% in our quality ratings. 99% and we address all issues.

This article addresses this, and it all boils down to finances.

If a hospital buys a $5 million MRI, they have to justify that expense, which means constant invoicing, add the interest on that money, and it takes serious effort, which Doctors support. Technology is expensive.

Anyone remember the movie "Papillon?" I get a kick of the old x-ray machine back in the 1930s at the jail. The Doctor in the movie says to Steve McQueen "these x-rays are useless, you know" LOL Anyway, great film.

Ed

Pooka1
03-27-2010, 12:20 PM
Let's say the US population in 2007 was ~300 million.

If there were 351K fusions then that is 0.00117 or 0.117% of the population had a spinal fusion. Let's round that to 0.0012 or 0.12%.

If 2%-3% of the population has scoliosis and only about 10% of those need fusion then that is 0.002 - 0.003 or 0.2% - 0.3%.

So the numbers don't jive... There are more people apparently fused just for scoliosis than the reported total. Maybe the 10% of scoliosis cases proceeding to fusion is too high? Is it ~ 1%? That would make more sense. If so, then it is 0.0002 - 0.0003 or 0.02% - 0.03%. which would mean that most fusions BY FAR (by a factor of 4 - 6) are not done for scoliosis and therefore might be useless surgery.

I hope that's right.

Pooka1
03-27-2010, 12:26 PM
There are approx 300,000,000 people in the US. 30million would be 10%, 3 million would be 1%, 300,000 would be .1%. 351,000 would be .15%

LOL. I had a major brain malfunction there. I tried to fix in in another post.


If the amount of scolis is 2-3%, then that means that there are 6-9 million scolis in the US. Where the heck is everybody????

There are many people with smaller curves and some with larger curves who don't realize it. That's why self-reporting is clearly nonsense and should be unpublishable.


Itís a shame that these fusions are considered "useless" If this continues, then something should be done as far as training is concerned.

Folks who say fusions for lower back pain absent scoliosis are useless have some ground to stand on. They are not talking about scoliosis fusions in my opinion. And I don't think it is lack of experience by the surgeons. I think it is surgery is simply not the answer in most cases of lower back pain absent scoliosis. The state of the art is not there or the condition is not amenable to a surgical approach or whatever.


Anyone remember the movie "Papillon?" I get a kick of the old x-ray machine back in the 1930s at the jail. The Doctor in the movie says to Steve McQueen "these x-rays are useless, you know" LOL Anyway, great film.

That movie was haunting. And it was based on a true story, yes?

LindaRacine
03-27-2010, 01:10 PM
Hi...

I literally see dozens of people with 1-2 level fusions every month. While I'm certain that a few of them have had bad outcomes, the vast majority have great outcomes. I saw one of our patients yesterday who had a 6-level scoli fusion. She's 70 years old. She had the surgeries in August and was skiing by December. She's not at all atypical.

Perhaps the facts are wrong. Or, maybe there are a lot of surgeons out there who shouldn't be doing fusions.

--Linda

titaniumed
03-27-2010, 01:26 PM
LOL I short circuit with bad #s. Lets drop the #s, Im off today, and I cannot see my calculator, cause Im going blind.

You know Im always wondering where all the scolis are?

I just cannot believe that with all the work Ive had done, with all the levels fused, that these single level non scoli fusions get botched so often. One wouldnít think that if a scoli trained surgeon that is working in a group, would do a non-scoli or single level. If would be given to one of the other non-scoli trained Doctors.

Yes, Papillon was true. Some of it.

I read the book 40 years ago, so I will try to remember. I do remember that he ended up in Caracas, and owned a bunch of restaurants and was wiped out in the 67 earthquake. He wrote the book because he was broke. I remember this because I was there the day after, and took the earthquake tour. I spent my summers growing up in South America, mainly in Medellin, Colombia. Ye-ha.
Ed

titaniumed
03-27-2010, 01:29 PM
Hi Linda

You are working with some of the best people out there. No doubt!

Have surgery in Notippycanoe, and stuff happens. LOL

Ed

loves to skate
03-28-2010, 07:06 PM
Hi...

I literally see dozens of people with 1-2 level fusions every month. While I'm certain that a few of them have had bad outcomes, the vast majority have great outcomes. I saw one of our patients yesterday who had a 6-level scoli fusion. She's 70 years old. She had the surgeries in August and was skiing by December. She's not at all atypical.

Perhaps the facts are wrong. Or, maybe there are a lot of surgeons out there who shouldn't be doing fusions.

--Linda
Hey Linda,
How come your 70 year old with a 6 level fusion can go skiing three months after her surgery and I'm told not to ski?:confused: Must be she is not fused to the sacrum. I'd rather be roller skating.:D
Sally

LindaRacine
03-28-2010, 07:31 PM
Hey Linda,
How come your 70 year old with a 6 level fusion can go skiing three months after her surgery and I'm told not to ski?:confused: Must be she is not fused to the sacrum. I'd rather be roller skating.:D
Sally

Hi Sally....

Different surgeons? :) This patient was fused to the ilium. I'm not sure she cleared it with the surgeon, but he's pretty liberal in terms of what he lets patients do after surgery. I'm certain that, if it was discussed, he told her not to fall!

--Linda

loves to skate
03-28-2010, 08:08 PM
Linda,
Dr. Rand was more concerned with someone skiing into me from the side; not so much worried about falling, because with roller skating, there is always the danger of falling.
Sally

titaniumed
03-29-2010, 01:55 AM
Linda-Sally,
She is a diehard skier.....I know her addiction. Im sure she took it easy. I would love to ski with her.

It has to be so hard for a surgeon to tell us we have to quit. Especially if that person is a skier. It was one of my priorities, when discussing surgery with my surgeon.

I delayed surgery as long as I could for skiing... at the end I couldnít handle the pain anymore. It was enough to drop a horse. I have come to the conclusion after reading here, that my recovery was a slow one, and thatís ok because now, I have no pain at all.

And your right, we are not allowed to fall. That really makes us aware, extremely defensive, non risk taking skiers. Itís a gamble we have to take.
Im fine as long as I donít ski faster than my angels can fly.
Ed

loves to skate
03-29-2010, 11:54 AM
Ed, I have fallen once on my skates in the year and 1/2 since my surgery, but my angel let me down easy - no damage done:), But where was she when I slipped on wet leaves and fell in my yard? One week's worth of pain from that fall.:eek: I do take it easy and only skate backwards when my coach is holding me up.
Sally

pmsmom
03-31-2010, 08:13 AM
Neither did either of my kids have a choice.

The decision was easy for us... no choice.

Amen! That was our situation as well.

In fact, our insurance didn't pay as much as they should have to cover the costs--well *less* than the "normal" average.

Yet our surgeon and everyone else involved took way less than, in my opinion, they deserved.

How do you put a price on someone giving your child back their life?

Pooka1
03-31-2010, 08:26 AM
Amen! That was our situation as well.

In fact, our insurance didn't pay as much as they should have to cover the costs--well *less* than the "normal" average.

Yet our surgeon and everyone else involved took way less than, in my opinion, they deserved.

How do you put a price on someone giving your child back their life?

I know! With kids at least, they look and feel normal only a few weeks out. Neither kid really respected the restrictions because they feel normal. It's impossible to convince them when they feel so good so early. Luckily the instrumentation is good enough so that virtually all kids can get away with ignoring the restrictions.

How this surgery has taken my bent and twisted kids and made them look and feel normal so quickly is easily the most amazing thing that I have witnessed in my life. And while they are not expected to ever need any more back surgery, even if they do several years from now, it is clearly WAY worth it to gain this normality back now and for the next several years. It is everything to a teenager and young adult I think.

Scoliosis treatment is about cutting losses; normal is no longer on the table for these kids and adults. Surgery now clearly cut their losses given the size and velocity of their curves. Forgoing surgery now for my kids would certainly have increased the losses overall. They are only young once and revision surgery, if they ever need it, will only get better into the future.

I'm very grateful for this surgery and the surgeons who do it.

foofer
03-31-2010, 09:25 AM
Pooka1/Sharon,

Your post just edged me closer to saying yes to surgery, even though I know it's different for young women than those at my age. Thinking of it as cutting my losses works for me, as opposed to "fixing it". 10 years ago, my doctor told me I would need surgery at some point, but hopefully closer to 60 than 50 because "the operation brings its own set of problems", so I told him my goal was to never have surgery. Now I'm 55 and hoping to prevent 60 from being the new 80. New motto: Think prevention, not cure.

Sally! ....I have an appointment with Dr Rand in May. Last November, I was tending to my mom at New England Baptist when she had hip replacement. I asked a phys therapist there if they did scoli operations and she told me about Dr Rand, and I remembered the name from the forum....I wandered over there and asked his assistant if he might have a few minutes to talk to me. He was behind the door and overheard- had her put me in a room and we talked briefly. Very kind man. ....

BUT...he told you not to ski?! Ever?! Now I'm worried...I'm the worst skiier in the world- 4 year-olds, 80 year-olds, and disabled skiiers on wheelchair skis pass me like I'm standing still, BUT ....I still want to go! Might have to rethink this one.

Ed, yes, where are all the scolis? I have thought of that a lot. My town has 5800 population; 2% is 116. I just made a list and so far, I can think of 12 of us. I wonder where they procured that #? Question # 2, how long did you wait to ski and what was the first day like? What is it like to ski with your bionic upper body? I know you like to go fast. My angels have to wait for me at the bottom.

Time to get ready for work. Big Sigh....

Amy/Foofer

Pooka1
03-31-2010, 11:32 AM
Pooka1/Sharon,

Your post just edged me closer to saying yes to surgery, even though I know it's different for young women than those at my age. Thinking of it as cutting my losses works for me, as opposed to "fixing it". 10 years ago, my doctor told me I would need surgery at some point, but hopefully closer to 60 than 50 because "the operation brings its own set of problems", so I told him my goal was to never have surgery. Now I'm 55 and hoping to prevent 60 from being the new 80. New motto: Think prevention, not cure.

Well I'm not trying to sway anyone but I'm glad it resonated with you.

I think some of the resistance to surgery in certain cases with kids at least is that it is so artificial and so far from normal. But it's not like normalcy awaits if you just somehow avoid surgery. It's about balancing multiple abnormal states and how best to cut losses. It is rarely, if ever, finding the normal again as that seems to be out of reach of most patients and will remain so until the molecular guys figure out how to prevent it.

Just my opinion watching the testimonials roll by...