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Is Good Medicine Driving High Back Surgery Rates?
A study by the University of Washington’s Center for Cost and Outcomes Research looked at spinal surgeries in the U.S. and confirmed some disturbing trends. In 2001, approximately 122,000 lumbar fusions were performed, representing a 220% increase from 1990. Were those surgeries more successful than in the past? It seems not. Reoperation rates actually increased during the 1990’s, with a cumulative rate of about 12% just three years after the initial surgery.
The Department of Health Services at the University of Washington has noted that there are large variations in back surgery rates across different parts of the country. The Department also found that “The rate of back surgery in the United States was at least 40% higher than in any other country and was more than five times those in England and Scotland. Back surgery rates increased almost linearly with the per capita supply of orthopaedic and neurosurgeons in the country.” That sounds more like supply-side economics than evidence-based medicine.
Meanwhile, the New England Journal of Medicine has published a new study of 283 patients with severe sciatica. The participants were randomly selected to have surgery early on, or to have extended conservative treatment and undergo surgery at a later time, if needed. Only 39% of this second group actually ended up having surgery. After one year, the outcomes were similar for those with early surgery and the conservatively treated group, although those receiving early surgery had somewhat faster pain relief and self-perceived recovery rates.
The decision to have surgery for back pain or sciatica due to degenerative conditions will usually be left to the patient. Trauma resulting in fractures, cancer, and other conditions causing back pain may permit fewer options. But for patients who are willing to participate in their own recovery, conservative treatment holds a lot of promise with very low risk. Surgery, after all, will remain an option. They may need to be more proactive in seeking out treatment. Learning stretches and other exercises from a skilled therapist will give them some control over their recovery. A willingness to try appropriate therapies and actively engage in the treatment process can lead to much greater success than simpler treatments involving only rest and drugs. Those who choose such a treatment plan may well be rewarded with a strong, pain-free body, and new knowledge that can help keep it that way.
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