Summary: Low Institute’s latest report indicates that US surgeons frequently carry out unnecessary low-value back surgeries. Many of these surgeries are done in patients who are unlikely to benefit. Hence, it underlines the need for careful patient selection for low back surgeries.
One of the latest reports by Low Institute says that every eight minutes, unnecessary back surgery is performed in the US. Yes, those are big and alarming numbers. The report says that most of these surgeries are “low value,” and they are not proven to help those living with low back pain. These surgeries are especially of little use for those experiencing age-related low back pain.
Low back pain is one of the leading causes of chronic pain in the US. It is also among the most challenging to treat, often requiring prolonged treatment. Quite often, even prolonged treatment fails to help. However, this does not mean that surgical correction is going to help – this is exactly what this new report suggests.
Chronic pain syndromes like low back pain are quite complicated, and they occur not just due to some structural changes in the spine. Such pain may occur for various other reasons, even mood disorders.
It is true that spine imaging frequently shows pathological changes in the spine. However, such changes are not rare in old adults. Studies suggest that such changes are not uncommon among those not experiencing low back pain. This shows that low back pain is not essentially due to those pathological changes.
This new report by the Lown Institute found that many unnecessary surgeries cost Medicare millions of dollars. Most of these low-value surgeries are laminectomies and vertebroplasties. They are often recommended to patients as low-risk procedures. These include the removal of part of the vertebra (laminectomy) or the injection of special material between the vertebra to cause fusion and stabilization (vertebroplasty).
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Since these are not major surgical interventions, they are often recommended as something that would not cause much distress to the patient and may help overcome low back pain. However, chronic pain specialists argue that there is insufficient proof that such procedures help reduce pain. They have limited value in managing low back pain due to aging or spinal fractures due to osteoporosis.
Experts from Low Institute say that people tend to trust doctors and think that if they recommend something, it might help. However, experts at the Institute argue that this is not always the case. Doctors frequently use treatments and procedures without paying sufficient attention to the clinical evidence.
Of course, Lown Institute does not suggest that surgery is of no use for lower back pain. About 30 million people in the US seek help each year for their spine problems. The chronic pain specialists want to say that though the surgery is a good choice in many patients, it is also overused in many instances.
Further, even these low-value surgeries come with some risks for patients, like infection, heart and lung problems, stroke, clots, paralysis, and even death. It is worthwhile to understand that most such surgeries are done in older adults who are already weak and living with multiple ailments.
To prove their point, researchers also say that there is a huge variance regarding the use of these procedures in the nation. Thus, in some places, the overuse rate was merely 1.2%, whereas in other places, it was as high as 32.6%. This massive variance also shows that some medical centers are overusing these back surgeries. If these surgeries were known to help, and the report was faulty, then the rate of overuse would not have that kind of variance.
Lown Institute says that their study shows that only a limited number of doctors seem to carry out most of these low-value surgeries, which raises many questions.
This is not the first report by the Institute, and previously, researchers at the Institute have questioned the use of such low-value surgeries and procedures for knee pain. They say that studies show that many such procedures, like knee arthroscopies, provide temporary pain relief with no long-term benefit. Interventional pain management in Saint Louis offer better, longer-lasting alternatives that address the root causes of pain without resorting to unnecessary surgery.
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/
