Spine fusion techniques are being scrutinized amid reports that there are many needless surgeries that pose health risks.
Spine fusion surgeries have increased dramatically in the past decade. An April 2010 study in the Journal of the American Medical Association found a 15-fold increase in the number of spinal fusion surgeries performed for Medicare patients between 2002 and 2007.
“You can see the spine infusion rates and there is really no doubt fusion operations are clearly being overdone,” says Kamal Thapar, MD, medical director of neurosurgery and tertiary care services at Sacred Heart Hospital in Eau Claire, WI. “We are held to standards of outcome and we have to demonstrate value.”
Bryan J. Massoud, MD, the CEO of the New Jersey Back Institute at the Spine Centers of America in Fair Lawn, NJ, says as spine surgeons evaluate patients, they are consistently confronted with a challenge. “Do we need to be doing all these things or are there some we don’t need to be doing?” he says. Spine fusion surgery is “definitely our last alternative,” Massoud says, but adds he will consider it after evaluating different treatment options.
“We always start with conservative measures first, such as chiropractic, physical therapy, pain medication. If there is still a problem, then we do injections. If a patient is not improving and having pain, then we evaluate to see if they are a candidate for endoscopy,” Massoud says.
“If the patient is still not improved and still having pain, radiating pain, or sciatica, then he or she is a candidate for endoscopic spine surgery,”he says.