Article Posted by Dr. Michael Raeburn, June 7th, 2011
I was doing some research on the effectiveness and cost of spinal surgeries and found a quote that made me laugh a little, and then it made me think a lot. Dr. David Spodick, MD, professor of medicine at the University of Massachusetts, has stated “surgery is the sacred cow of our health care system and surgeons are the sacred cowboys who milk it”.
Now I’m certainly not looking to tick off all the surgeons out there but I do want people to know that in today’s healthcare system surgery should not be the first option for back pain associated with disc degeneration, disc herniation and radiculopathy. Obviously pathologic conditions such as tumors, infections, cauda equine syndrome and the like require prompt surgical attention. Otherwise a trial of conservative care should be considered.
Often individuals with chronic back pain get wrapped up in a medical system that can create a cycle of pharmaceutical dependence and an inevitable trip to the surgeon. Dr. Sherman Cherkin DC and Dr. Richard Deyo, MD, a professor at Oregon Health Sciences University conducted a study in 1994 to compare international rates of back surgeries and found that in the U.S. surgery is unusually excessive and is directly attributed to the supply of spine surgeons: “The rate of back surgery in the United States was at least 40percent higher than 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 orthopedic and neurosurgeons.” In 2006, doctors performed at least 60 million surgical procedures of all types, that’s one for every five people in the U.S.
Many of these procedures are ineffective and very expensive, creating huge profits for hospitals and doctors. Back pain is considered 8th on the top ten lists of diseases in the U.S. and according to Forbes.com costs over $40 billion annually for treatment costs alone. Some estimates that factor in work loss, disability, imaging and other indirect costs range from $100 to $200 billion a year. Here is a list of pre-surgery costs for various back surgeries, not including any imaging rehabilitation or indirect expenses:
Anterior cervical fusion: $44,000
Cervical fusion: $19,850
Decompression surgery: $24,000
Lumbar laminectomy: $18,000
Lumbar spinal fusion: $34,000
Dr. Deyo’s research looked into the total final cost of these procedures and found that the average spine surgery case approaches $100,000 or more, and can be as high as $169,000 for a lumbar fusion. These costs could be justified if the outcomes were better, but they’re not.
Expense aside there is still the inherent risk of surgery itself to consider. According to Barbara Starfield, MD, MPH, of the Johns Hopkins School of Hygiene and Public health, medical health care is now the third leading cause of death in the U.S., causing 225,000 preventable deaths every year.
Now I don’t want to come off as anti-surgery or anti-medicine because I’m certainly not. But if you’re about to make a decision that will shape the rest of your life, for better or worse, it should be an informed decision. Often conservative care is ignored by mainstream providers and is never brought forth as an option. However, the evidence is piling up and it’s showing that chiropractic and other non invasive therapies and procedures produce better patient satisfaction, better outcomes and are vastly more affordable.
Article by: Dr. Michael Raeburn
Certified Chiropractic Sports Physician