Response to Our Findings
We shared our findings with Dr. Daniel Resnick, Vice Chair of Neurosurgery at the University of Wisconsin School of Medicine and President of the Congress of Neurological Surgeons. He spoke on behalf of himself, not the organizations he is affiliated with.
Dr. Resnick said our findings concerned him. He said they suggest that while most doctors are careful about recommending a fusion, some may be "operating outside of the generally agreed upon (based on common practice and literature supported guidelines) parameters." He added that data on reoperation rates and complication rates should also be made public. That information is "critical to make any value judgments regarding the frequency of procedures performed," he said.
Dr. Resnick added that Medicare, medical societies, and credentialing bodies (including state medical boards and the American Board of Medical Specialties) should use databases like the one in this story to follow practice patterns and patient outcomes. He said surgeons with the highest numbers should be closely looked at and asked to explain themselves. But he said that won't happen without a source of funding, as the work is time consuming and entails legal risk.
Dr. Resnick also emphasized that there are many cases where spinal fusions are clearly necessary. The procedure is widely accepted for treating major spinal deformities (like scoliosis), fractures, tumors, infections, and spondylolisthesis (slipped disc) in the lower back. But some of the nation's top spine surgeons say they rarely perform it for simple back pain, degenerated discs (or "degenerative disc disease"), stenosis (a narrowing of the spinal canal), or a herniated disc.
More than 480,000 spinal fusions are performed in U.S hospitals each year, making them more common than even hip replacements. The annual cost of these surgeries is more than $12 billion, according to the Agency for Healthcare Research and Quality. Experts disagree about how many may be unnecessary, but Dr. Richard Deyo, a critic of the procedure and professor at Oregon Health and Science University believes it could be as much as half. For Medicare and Medicaid patients, taxpayers foot the bill.