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Thread: Are spinal fusions wasted money?

  1. #1
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    Are spinal fusions wasted money?

    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 useless—but 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
    1966 fusion in Buffalo of 11 thoracic vertebrae, with Harrington rod

  2. #2
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    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.

  3. #3
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    Thanks! I wondered if they were just referring to low back pain situations, but the article did not say that at all.
    1966 fusion in Buffalo of 11 thoracic vertebrae, with Harrington rod

  4. #4
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    Quote Originally Posted by JulieBW View Post
    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.
    Fusion is NOT the end of the world.
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  5. #5
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    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?

  6. #6
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    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.

  7. #7
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    Edited to say this analysis I previously wrote is completely wrong... I'll work on it and re-post.

    More coffee please.
    Last edited by Pooka1; 03-27-2010 at 01:11 PM.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  8. #8
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    Quote Originally Posted by RitaR View Post
    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.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  9. #9
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    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 don’t 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....

    It’s 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 don’t 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
    49 yr old male, now 58, the new 53...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  10. #10
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    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.
    Last edited by Pooka1; 03-27-2010 at 02:28 PM.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  11. #11
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    Quote Originally Posted by titaniumed View Post
    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.

    It’s 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?
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  12. #12
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    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

  13. #13
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    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 wouldn’t 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
    49 yr old male, now 58, the new 53...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  14. #14
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    Hi Linda

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

    Have surgery in Notippycanoe, and stuff happens. LOL

    Ed
    49 yr old male, now 58, the new 53...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  15. #15
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    Quote Originally Posted by LindaRacine View Post
    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? Must be she is not fused to the sacrum. I'd rather be roller skating.
    Sally
    Diagnosed with severe lumbar scoliosis at age 65.
    Posterior Fusion L2-S1 on 12/4/2007. age 67
    Anterior Fusion L3-L4,L4-L5,L5-S1 on 12/19/2007
    Additional bone removed to decompress right side of L3-L4 & L4-L5 on 4/19/2010
    New England Baptist Hospital, Boston, MA
    Dr. Frank F. Rands735.photobucket.com/albums/ww360/butterflyfive/

    "In God We Trust" Happy moments, praise God. Difficult moments, seek God. Quiet moments, worship God. Painful moments, trust God. Every moment, thank God.

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