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Thread: Spinal Fusion Rates Back in the News

  1. #1
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    Spinal Fusion Rates Back in the News

    http://www.cbsnews.com/news/tapping-...back-surgeries

    I looked up a bunch of the top scoliosis surgeons. Most of the rates (percent of patients who had fusion surgery) are between 7% and 17%. Some of the more interesting numbers:

    Bridwell 7%
    Lenke 17%
    Hey 27%

    The national average for all spine surgeons is 7%. It's no surprise that scoliosis specialists are higher, as most of the top guys do little to no small surgeries (mostly standalone decompressions).

    Note: Surgeons who don't accept Medicare reimbursement are not in this database. Note2: If you want to look someone up, be sure to type the name in ALL CAPS.
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  2. #2
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    Well that is pretty interesting but I think long fusions for AIS in adults are a tiny fraction of these fusions they are talking about. The few level fusions for back pain in most patients which account for the vast majority of fusions are known to be not a good idea as far as I know. A few years ago I read that was the most over-used surgery out there.

    To the extent that the surgeons we discuss here seem to focus on long fusions for AIS, I think their stats just reflect their focus on AIS and their prominence, not that they are doing too many fusions in adults for AIS.

    Now I think it would be interesting to see how many of the fusions these guys we talk about are the few level over used type not related to AIS. That would be relevant to the stats posted. But it is a red herring to put someone up like Lenke or Hey who probably only does long fusions against the guys who probably only do the few level fusions. The long fusions for AIS in adults have demonstrated benefit whereas the few level fusions for back pain are the most over-used surgery. Apples and oranges.
    Last edited by Pooka1; 04-25-2014 at 07:00 AM.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
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  3. #3
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    data doesn't make sense

    I read through the article and looked up my own surgeon (Dr Robert Hart in OR), as well as the docs Linda mentioned. The table data is confusing, because it appears to list 0 complex fusions (4 or more levels) done by Lenke and Hey, which can't possibly be accurate. It lists my surgeon as doing a moderate number of complex fusions.

    Linda, what do you make of this data? It seems very inaccurate when two big names in scoliosis who are known to do lots of long scoliosis fusions are listed as doing none. This makes me very skeptical of the accuracy of the whole article.
    Gayle, age 49
    Oct 2010 fusion T8-sacrum w/ pelvic fixation
    Feb 2012 lumbar revision for broken rods @ L2-3-4
    Sept 2015 major lumbar A/P revision for broken rods @ L5-S1


    mom of Leah, 15 y/o, Diagnosed '08 with 26* T JIS (age 6)
    5/10 VBS Dr Luhmann Shriners St Louis
    5/16 6 yrs post-op, 24*T/ 22* L, mild increase in curves, watching

    also mom of Torrey, 12 y/o son, 16* T, stable

  4. #4
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    I don't think this is relevant to scoliosis patients. I WANT a doctor who does a LOT of fusions over a doctor that does very few.
    Low back pain is a different monster than scoliosis, so it's apples and oranges.
    I think this subject is totally irrelevant because to belong to the SRS a doctor HAS to have a large percentage of his/her patients with scoliosis.
    A large percentage of scoliosis patients end up with fusion, especially with these top guys who ONLY take surgical cases.
    It makes them look bad.
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  5. #5
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    I agree that you can't compare the top scoliosis specialists with other back surgeons. (I thought I made that clear with my statement "It's no surprise that scoliosis specialists are higher, as most of the top guys do little to no small surgeries (mostly standalone decompressions).")

    You can, however, compare scoliosis specialists to each other, at least to some extent. The fact that Hey does 4 times as many fusions as Bridwell is interesting. Bridwell is super conservative. He chooses patients whom he feels strongly he can help. I suspect that Hey isn't quite as discriminating. While I think we can compare scoliosis specialists to one another, there is one thing that wasn't discussed in the article. Some surgeons (e.g., Lenke) make it very difficult to get an appointment. You have to prove to Lenke's people that you are a good complex surgical case before you get the first appointment. Most of the top specialists do this to some extent, but probably not as strictly as Lenke. Therefore, Lenke probably has a fairly high percentage of fusions because he does more prequalifying.

    Rohrer, all of the top scoliosis specialists do a very high percentage of fusions based on the surgeries they do. Picking someone who does a high percentage of fusion surgeries per PATIENT would not be a great strategy. What you want is someone who does a high percentage of fusions per SURGERY. (For example, sticking with the Lenke example, he does 17% of fusions per patient, but probably close to 100% of fusions per surgery.)

    I did notice the issue regarding long fusions, and am not absolutely certain what to make of it. I think it's an issue with how surgeries are coded. I know that Medicare and other payers max out reimbursement at (I think) 4-7 levels. (For example, surgeons get the same reimbursement for 7 levels as they do for 15 levels.) Because of that, many surgeons/centers haven't used accurate coding, as it just doesn't make any difference. There's no incentive to use the correct coding. I sent an email last night to someone who knows the data fairly well.
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Dilbert
    I'm sarcastic... what's your super power? --Unknown
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    If you've signed up and are having trouble posting, please check your spam folder. An email was sent to the email address which you subscribed. You have to follow the instructions in that email. Done that and still having trouble posting? Contact Joe O'Brien at jpobrien@scoliosis.org.

  6. #6
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    I totally agree that I don't want to see someone who will see any scoli patient and operate on most of them. That's not what I was trying to imply.
    Although Pooka1 holds Hey in high regard, my experience with his wasn't so great. After my first phone call I had a funny feeling. Then as I talked back and forth with his office staff I settled down a bit. But he was making some pretty huge offers to me that I shouldn't post here. Then the office staff said he wouldn't. Nothing was consistent. Then when they couldn't get my insurance approval for surgery, he cancelled my consult. I only wanted a consult to begin with. Then it turned to surgery pretty quickly. There are good reasons that I would have gone with him such as quick OR times and minimal blood loss, not even using any kind of transfusion and very rarely even the cell saver. That impressed me a LOT. The fact that he'll operate on just about anyone does not impress me. I think the most important statistic relevant to spinal fusion is patient satisfaction. They are coming up with newer technologies for lumbar pain and using artificial discs INSTEAD of fusions now. I was offered that option when mine gets bad enough. I would go there any day over a fusion. With these discs, mobility isn't lost.

    But my guy here hasn't had very many patients like me if any. THAT makes me very nervous. I want someone who has seen curves like mine and operated on curves like mine. I haven't met one yet that has even seen a curve like mine. EVERY single surgeon that I've seen gives me a puzzled look and makes some comment on how odd my curve is. That is very disconcerting.

    It's frustrating, especially when you look at statistics, to find a competent doctor. In my case my neck and upper T-spine are now starting to twist. My L-spine is twisting, too. But the real problem lies in the neck area. Major blood vessels and nerves to my arm are getting pinched off because of the contortion of my neck, coupled with the cervical dystonia. All of my doctors are frustrated because there seems to be no one out there that can help me. So they manage it the best that they can. What's going to happen when they can't manage it any more. Am I going to lose my arm? My scoliosis is so unique that even though it's a grey area curve, surgically speaking, it's causing damage and changes in anatomy that you only see with the very large curves.

    So for me at least, it's apples and oranges. I don't care about statistics of 2 - 3 level fusions for lumbar pain AND I'm a lumbar pain sufferer.
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  7. #7
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    If Lenke mainly does long fusions and only takes very bad cases, then if his rate is only 17%, he is turning down MOST people who come to see him based on their co-morbidities I think. It is the co-morbidites that drives the outcome in these patients per that one article.
    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 Pooka1 View Post
    If Lenke mainly does long fusions and only takes very bad cases, then if his rate is only 17%, he is turning down MOST people who come to see him based on their co-morbidities I think. It is the co-morbidites that drives the outcome in these patients per that one article.
    Why would Lenke's rate only be 17% if he only takes the tough cases? I don't trust the data.
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  9. #9
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    Quote Originally Posted by rohrer01 View Post
    Why would Lenke's rate only be 17% if he only takes the tough cases? I don't trust the data.
    Rohrer, I agree with you about not trusting the data. It seems very inaccurate to say Lenke and Hey did no complex fusions, and I doubt this discrepancy is just due to improper coding issues. I am always leery of this type of sensational-style expose articles, as they are frequently lots of hype that can scare off people who actually do need surgery.

    I had a woman at the gym express disapproval about my surgery after noticing my scar (talk about a rude unsolicited opinion!!). She was very pious and went on to say that when her back hurts she uses a hot pack. People like this are fueled by poorly-researched expose articles in popular media.
    Gayle, age 49
    Oct 2010 fusion T8-sacrum w/ pelvic fixation
    Feb 2012 lumbar revision for broken rods @ L2-3-4
    Sept 2015 major lumbar A/P revision for broken rods @ L5-S1


    mom of Leah, 15 y/o, Diagnosed '08 with 26* T JIS (age 6)
    5/10 VBS Dr Luhmann Shriners St Louis
    5/16 6 yrs post-op, 24*T/ 22* L, mild increase in curves, watching

    also mom of Torrey, 12 y/o son, 16* T, stable

  10. #10
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    I could be wrong but I think the data is all based on medicare patients... So it is very skewed in many regards.
    66 and still heartbroken...
    2007 52° w/ severe lumbar stenosis & L2L3 lateral listhesis (side shift)
    5/4/07 posterior spinal fusion T2-L4 w/ laminectomies and osteotomies @L2L3, L3L4
    Dr. Kim Hammerberg, Rush Univ. Medical Center in Chicago

    Corrected to 15°
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    Click to view my pics: pics of scoli x-rays digital x-rays, and pics of me

  11. #11
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    Quote Originally Posted by rohrer01 View Post
    Why would Lenke's rate only be 17% if he only takes the tough cases? I don't trust the data.
    Because the tough cases might mostly come with co-morbidities.

    I also don't trust the data.
    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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    Quote Originally Posted by leahdragonfly View Post
    I had a woman at the gym express disapproval about my surgery after noticing my scar (talk about a rude unsolicited opinion!!). She was very pious and went on to say that when her back hurts she uses a hot pack. People like this are fueled by poorly-researched expose articles in popular media.
    People like that don't have real back pain, at least no bad enough to warrant going to the doctor. If that woman had the kind of pain that we endure, she'd be driven to the ER. How rude!
    Be happy!
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  13. #13
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    Its hard to decipher who, how, and why specific surgeons decide and elect to do Medicare patients. Some are done, and some are handed off by scoliosis surgeons. Some non-scoli spine surgeons might possibly bill Medicare.....and get banned by hospitals like in the video. They don’t have the option to do the high pay long fusion scoliosis surgeries. Surgeons that decide on fusing based on billing....like in the video again will eventually get caught by hospital personal who analyze the stats....(Very important people!) Is it helping the patient or is the surgeon motivated by greed or power? “A pioneer in the treatment of back pain” That’s a good one! LOL He might as well stated that he was a miracle worker on his web page.

    Hospital admin doctors will also bill Medicare for completely unnecessary stays like when my dad had ALS. Nothing changed really, except that my dad got ice cream every night for 10 nights and all for 48K. (In 2000) What are you going to do? ALS is terminal, there are no answers. I started to ask the hard questions and this doctor flat out ignored me and walked away.....Motivated by money? Of course....How stupid of me. And yes, that hospital sold. Reality check. Brand new $500 million dollar hospitals have to get paid for somehow.....

    Highly trained scoliosis surgeons also might do a non-scoli 3 level on Medicare because they know deep down that a particular patient will not come through without their expertise.

    There is also the trauma scenario when someone is flown in after an accident and a scoli surgeon just might be there and cant leave without helping out. (compassion scenario)

    I think its very important to know what motivates your surgeon. I knew it was important for me to find this out, and had plenty of exposure to medical professionals that were driven by the almighty dollar.....Maybe it was part of my “selection” training dealing with these scenarios, but reading people and asking the right questions were things I became pretty good at.

    Integrity and intent, training and goals, experience and reality, compassion and love.

    Things to know....

    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

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    http://www.scoliosis.org/forum/showt...on.&highlight=

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

  14. #14
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    I'm pretty sure that my scoli doc has to do ER rotations for privileges at the hospital where he works and does surgery. They are a level 1 trauma center. The hospital in my area is a level 2 trauma that flies out the super critical cases to the other hospital. The level 2 center HAS to have specialists in every department on hand at all times and be in proximity to a level one. I asked. I'm pretty sure the level 1 has to do with even more doctors on hand in case several similar traumas come in, not sure. I know that my scoli guy can do anything orthopedic. Surprisingly, my hometown hospital is rated a level 3 trauma center. I about choked. cough cough.... But they did get rid of one of the worst doctors there. Someone had to graduate last in his class. I'm guessing the complaints were just too many. They have a guy, actually from here, that is very sharp working there. So there's been some great improvements. They have strictly ER doctors now at the hometown.
    Be happy!
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  15. #15
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    To the first statement of my last post, that would skew his data being on trauma duty.
    Be happy!
    We don't know what tomorrow brings,
    but we are alive today!

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