Spinal Fusion Surgery: On the Rise but Often Not Necessary

One of the most common complaints doctors hear from their patients involves low back pain.  Results from a 6-month CBS investigative report of Medicare patients during a two-year period from 2011-2012 reveals that spinal fusion surgery is frequently performed to relieve low back pain, and that many of these fusion surgeries are unwarranted, unnecessary and cause greater problems for the patient than their initial complaints.

More than 480,000 spinal fusion surgeries are performed each year in the United States and between 2001 and 2011, spinal fusion surgeries increased by more than 70%. A portion of the nearly half-million fusion surgeries performed annually may be explained by an aging population that is more active than previous generations, and who want to continue their active lifestyles. But experts consulted for this study are concerned that the high number of spinal fusion surgeries may be also due to an increased number of unnecessary procedures being done for low back conditions that do not warrant spinal fusion.

There are several conditions for which medical experts agree that spinal fusions are medically appropriate including severe spinal deformities such as scoliosis, for spinal fractures and tumors, and infections in the spine.  The data unveils, however, that spinal fusions are now routinely performed for low back complaints due to degenerative disc disease, spinal stenosis (narrowing of the spinal canal), and for treatment of herniated discs. Medical experts recommend a more conservative approach to these complaints but too often fusion surgery is proposed.

Some surgeons perform a greater number of fusion surgeries than the annual national average. The data from 2011through 2012 showed that on average during a given year, spine surgeons see 651 Medicare patients, perform around 43 spinal fusion surgeries (7%), and of that number, perform multi-level fusions involving 4 or more vertebrae on 7 or fewer patients, less than 1% of patients seen.

Some spinal surgeons, however, perform an exorbitant amount of fusion surgeries and that is where questions of medical appropriateness and necessity arise. Surgeons who do more fusion surgeries may simply have a greater number of fusion candidates because of the increased referral rate due to his/her excellence. Some surgeons may perform a greater number because they practice in a rural area, or in an area of the country where there are fewer spinal surgeons. The number of fusion surgeries may also be explained by a difference of opinion on medical necessity among experts.

Concerns arise where neither of these exceptions exists, and where a surgeon is performing an extraordinary number of fusion surgeries that greatly exceed the national average. The data showed that where the national average for a two-year period is approximately 43 spinal fusions, some surgeons performed closer to 460 fusions during the same two-year period.

What is the explanation for this huge discrepancy?

Most doctors have their patients’ best interest at heart, but for some, money is the motivating factor in recommending spinal fusion. Fusion surgeries can cost upwards of $50,000, and some patients will require more than one surgical procedure increasing the cost even more. The Agency for Healthcare Research and Quality reports that spinal fusion surgeries’ total annual cost exceeds $12 billion.

For patients undergoing a multi-level fusion surgery involving 4 or more discs, the monetary rewards are even greater for the surgeon who is paid more when more vertebrae are fused. For multi-level fusion surgeries, the data was even more startling revealing that some surgeons performed more than 100 of these types of fusion surgeries compared to the national average of 7.

If you suffer from low back pain, and your surgeon recommends fusion surgery, here are a few questions you should pose before proceeding:

  • Have all conservative treatment measures been exhausted including physical therapy, spinal rehabilitation, weight loss, pain medication, etc., before fusion was surgery recommended?
  • Why is spinal fusion recommended over other treatment options?
  • How many spinal fusions has your surgeon performed over the last several years? If the number exceeds the national average, ask your surgeon why. If your surgeon will not answer these questions, it’s time to find another doctor.
  • What is the rate of re-operation? Complications? Bad results? All medical procedures carry some risk, and bad results occur even with the best care, but it is important to be informed about all these issues before deciding whether to proceed with spinal fusion.
  • Who does your surgeon recommend for a second opinion on the necessity of a spinal fusion? If your surgeon discourages you from getting a second opinion, find another doctor.
  • Does your surgeon plan to implant a bone growth hormone or bone stimulator in your spine? If so, check out our link about the many problems associated with using Infuse® Bone Graft at www.infuselawteam.com.

And if you feel you had an unnecessary spinal fusion, or are suffering ill effects from that fusion, contact the legal professionals in our office for a free consultation and evaluation of your case.