Controversy Over Spinal Fusion

Debate over spinal fusion surgery continues to occur. A recent article tiled “Spinal fusions serve as a case study for debate over when certain surgeries are necessary,” appears in the Washington Post written by Peter Whoriskey and Dan Keating and published on October 27, 2013. (Note I have previously mentioned some of the controversy over spinal fusion in the post Tips to Prevent Medical Errors – AHRQ)

The article mentions that spinal fusions being performed in the U.S. has risen over the years and that around half of the surgeries they reviewed don’t meet expert consensus on when the surgery should be performed.

This article discusses a surgeon at a Florida hospital who was earning well over a million a year performing spinal fusions on patients. Auditors at the hospital began to wonder if all the cases were necessary and paid for an independent review which showed that 9 out of 10 cases was not medically necessary. A lawsuit emerged which provided several details on the financial arrangements between the doctor and the hospital. For example, the surgeon earned additional money beyond his base salary for each procedure after a certain threshold. The surgeons at the hospital were charging patients around $80,000 for each spinal fusion. The companies that sell the hardware used for spinal fusions often would have a representative present and stood to make up to $7,000 for each spinal fusion.

The article later touches on that Medicare hires contractors to issue payments to doctors and they are paid based on how many claims they approve. Furthermore, the restriction of paying doctors for some care and not other care has been contentious as the government has had issues reviewing the effectiveness of medical treatments. As discussed in my previous post, the Agency for Health Care Policy and Research was created in 1989 to produce evidence-based, clinical-practice guidelines. However, a few years later they suggested that spinal fusion is not always warranted. This caused numerous backlash by the medical industry and doctors and the agency was basically crippled and remains so today.

The article states

“The rate of spinal fusions in the United States is about 150 per 100,000 people, according to federal data. In Australia, it is about one-third of that; in Sweden, it is about 40 per 100,000; and in Britain it is lower still.”

Some suggested reasons are that patients in the U.S. are more likely to have surgery but that doesn’t seem to tell the whole story.

The article later addresses how spinal fusions for problems of the lower back are not recommended generally by experts yet many of these surgeries have been performed. A mention is made that a non-surgical option in this case exists known as decompression but is much less costly than surgery.

The article mentions that an insurance company denying spinal fusion surgeries are just trying to increase their profit margins.

The article mentions how the surgeon in the article warned several patients that they were going to be crippled if they don’t have the surgery. However, these patients were left with lasting complications after the surgery.

The article jumps around a bit so it is a bit hard to follow. I wanted to highlight this article though as there are some similarities with the removal of wisdom teeth (third molars) that I see, although this doesn’t seem to get touched on much in the media (see for example Bupa Ends Covering Wisdom Teeth Extractions Deeming Them Unnecessary ). However, there are also some apparent differences such as the fees involved with surgery.