Complicated Back Surgery Make Sense? Unnecessary?

Nearly every week, I hear about a person who had a surgical procedure to relieve horrible chronic back pain and found themselves with worse symptoms than before. Among the list of most significant concerns is that money inspires surgeons to persuade people into much larger and more sophisticated operations than they really require -- and then those surgeries result in foreseeable complications.

The greed accusation appears to be a bit harsh, but it comes straight from the top: The Journal of the American Medical Association, in an editorial by a leading Stanford orthopedic surgeon, Eugene Carragee, and in a study carried out by a group of medical professionals at Oregon Health and Science University led by Dr. Richard Deyo.

The Oregon analysis discovered that the amount of elaborate surgeries for back ache in Medicare patients jumped by 15-fold over a recent five-year period, but there was next to nothing in the patient population -- for instance increasingly intricate back deformities -- to justify the increase.

Surgical rates for rather simple decompressions are in the ball park of $600 to $1,000. The complex surgical treatments generate surgical professionals about 10 times more. Yet another likely component is the tendency for both doctors and people to go for a new, more high priced approach just because it sounds better.

The challenge is that the more elaborate surgeries have at least double the threat of a bad outcome, according to the research.

Nearly all back discomfort that isn't alleviated effectively with medicines or other non-surgical therapies is attributable to disk herniation or spinal stenosis. Spinal stenosis is growth of bone in the vicinity of a nerve travelling out of the spinal cord which presses on the nerve root and causes pain to travel down a leg. The majority of individuals who require back surgery because of spinal stenosis can be benefited from a relatively simple lumbar decompression. This will involve removing bone, ligament and facet joint material which is compressing the nerve root. This surgery has a high degree of success as it's been evolved over the last 20 years.

According to one editorial, if the patient also has some deformity of the spine -- front to back or side to side -- the simple lumbar decompression can cause spine instability with increased deformity, so those patients might require a fusion where by adjacent vertebrae are fixed together with bone grafts. Even in these cases, simpler procedures get just as good results than more complicated operations that add metal or other instrumentation into the back.