Summary: A Lown Institute report finds that an unnecessary back surgery is performed in the US every eight minutes. Most of them are low-value laminectomies and vertebroplasties. Many of these surgeries are done in patients who are unlikely to benefit. So the report shows the need to choose patients for low back surgery with care.
One of the latest reports by Lown Institute says that every eight minutes, an unnecessary back surgery is performed in the US. Yes, those are big and alarming numbers. The report says most of these surgeries are “low value,” and they are not proven to help those living with low back pain. These surgeries are of little use, above all, for low back pain that comes with age.
Low back pain is one of the leading causes of chronic pain in the US. It is also among the hardest to treat, and it often needs long treatment. Quite often, even long treatment fails to help. But that does not mean surgery is going to help. That is exactly what this new report suggests.
Chronic pain like low back pain is quite complex. It does not come only from structural changes in the spine. Such pain may have many other causes, even mood disorders.
It is true that spine scans often show abnormal changes in the spine. But such changes are not rare in older adults. Studies suggest such changes are not uncommon in people with no low back pain at all. This shows that low back pain does not always come from those changes.
This new Lown Institute report found that many unnecessary surgeries cost Medicare millions of dollars. Most of these low-value surgeries are laminectomies and vertebroplasties. Doctors often recommend them to patients as low-risk procedures. They include removing part of the vertebra (laminectomy) or injecting a special material between the vertebra to cause fusion and stabilization (vertebroplasty).
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These are not major operations. So they are often recommended as something that would not cause the patient much distress and may help with low back pain. However, chronic pain specialists argue there is not enough proof that these procedures reduce pain. They have limited value for low back pain from aging or for spinal fractures from osteoporosis.
Experts from the Lown Institute say people tend to trust doctors. They think that if a doctor recommends something, it might help. But experts at the Institute argue this is not always the case. Doctors often use treatments and procedures without paying enough attention to the clinical evidence.
Of course, the Lown Institute does not say that surgery is of no use for lower back pain. About 30 million people in the US seek help each year for spine problems. The chronic pain experts want to make one point. Surgery is a good choice in many patients, but it is also overused in many cases.
Even these low-value surgeries carry risks for patients. These include infection, heart and lung problems, stroke, clots, paralysis, and even death. Keep in mind that most of these surgeries are done in older adults who are already weak and living with several health problems.
To prove their point, researchers also point to a huge gap in how often these procedures are used across the nation. In some places, the overuse rate was only 1.2%. In other places, it was as high as 32.6%. This massive gap also shows that some medical centers are overusing these back surgeries. If these surgeries were known to help, and the report was wrong, the overuse rate would not swing that much.
The Lown Institute says its study shows that a small number of doctors seem to do most of these low-value surgeries. That raises many questions.
This is not the Institute’s first report. Before this, its researchers questioned low-value surgeries and procedures for knee pain. They say studies show that many such procedures, like knee arthroscopies, give short-term pain relief with no long-term benefit. Interventional pain management in St. Louis offers better, longer-lasting options that address the root causes of pain without turning to unnecessary surgery.
Frequently asked questions
How common is unnecessary back surgery?
A Lown Institute report found that an unnecessary back surgery is performed in the US every eight minutes. Most are low-value laminectomies and vertebroplasties. They are often done in older adults who are unlikely to benefit. The report also found that these surgeries cost Medicare millions of dollars. And a small number of doctors perform most of them.
Is back surgery worth it?
For many patients, yes. The Lown Institute does not say surgery is useless for low back pain, and it is a good choice in many patients. The problem is overuse. Low-value procedures such as laminectomy and vertebroplasty have little proof that they reduce pain. That is most true for low back pain that comes with age, or spinal fractures caused by osteoporosis.
What are the risks of back surgery?
Even the smaller, low-value back surgeries carry real risks. These include infection, heart and lung problems, stroke, blood clots, paralysis and even death. Those risks weigh more because most of these operations are done in older adults who are already weak and living with several other health problems.
Source:
Unnecessary back surgeries cost Medicare up to $600 million annually. (n.d.). Lown Institute Hospital Index. Retrieved November 26, 2024, from https://lownhospitalsindex.org/unnecessary-back-surgery/
Dr. Gurpreet Singh Padda, MD, MBA, MHP
